7% Saline Prescription and Medicare Part B payment quandry

Posted by Elle @ellen1944, Jan 28, 2023

My husband is 81, diagnosed with MAC, and has been on the 3-drug regimen for 2.5 weeks. He uses a nebulizer 2XDay with 7% saline.

Problem: Humana won't cover the saline prescription because they say it is covered under Medicare Part B. But, when filling the saline prescription the pharmacist can't get Medicare Part B to work. Our secondary (not supplemental) health insurance Blue Cross/Blue Shield says (thinks?) it needs to be coded as a durable medical, which neither CVS nor Medicap will use. (It seems to me that while the nebulizer is a durable medical; the saline is more a prescription.) In the meantime, we are paying out-of-pocket for a saline prescription the pulmonologist and all others say should be covered under Medicare Part B. Anyone else had this experience? How was it resolved? Many thanks!

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CVS told me that in order for Medicare Part B to reimburse for saline solution, your pulmonologist must prescribe another medication along with the saline solution.
I don’t understand the reasoning behind this, and have not talked to the pulmonologist about it yet.

REPLY

Dear Elle,
I have finally given up on getting the saline covered by Medicare. Have you tried using a GoodRx coupon? I just checked on their current prices. Both Walgreens and Walmart have the cheapest prices, but good only one time. Otherwise, CVS' prices are as follows: 60 vials (1 box) $11.97, 120 vials, $20.15, 180 vials, $25.55, and 240 vials, $30.95. If you can find Sue's (our mentor) entries, she explains how she has gotten Medicare to cover saline. Good luck! Donna T

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