7% Saline Prescription and Medicare Part B payment quandry
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!
Interested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.
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.
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