Medicare and hypertonic saline

@pocojack Well, I was at Mayo for a conference last week, and I asked one of the pharmacists in attendance why this is such a difficult issue for those of us on Medicare.
He said several things - one was that with the complexity of Medicare regulations, there is a highly specific "path" to follow - Rx for nebulizer, another covered inhalant and 7% saline - all under Medicare, then the 7% saline and the other inhaled Rx are both covered under Part B. Miss one of those, and many insurers balk, making the pharmacies reluctant to deal with them. Usually what happens is the pharmacy you use doesn't handle nebulizers, so it comes from somewhere else, and you miss one leg of the stool.

The other thing he said is that, technically, since 7% saline does not require a prescription, Medicare is not required to cover it. An analogy would be when they cover a CPAP machine, which is durable medical equipment, but not the distilled water to use in it, because it is not an Rx item.

So, welcome again to the Wild, Wild West of modern medical coverage. I guess it depends how persistent your pharmacist is, and how savvy in using exactly the right codes for every piece of the puzzle.

Sue

Thank you very much. Makes sense but in the end nonsense!

Well, I have long sense given up trying to make sense of the complex rules surrounding insurance, Medicare, etc. In my own policy last year, I found one paragraph that said a prescribed drug was covered, and one paragraph in a different section and on a different page that said "but not for [xyz] condition. Guess which one the insurer invoked?

Sue

Hi. I think it's covered under Part B, but your pharmacist should know. Good luck!

I have AETNA medicare advantage PPO and they do cover my 3% saline solution. I have not had anything that I needed rejected but they do not contract with Mayo and I am thinking about switching to a different plan. So if you have any advantage (Mayo called it disadvantage when i called to make an appointment) ask what hospitals they have contract with. NJ does accept most plans though.

I was told by a pharmacy about the three arms to get medicare coverage - the nebulizer machine; a solution to be nebulized (like albuterol) and the sodium chloride. As I understand it sodium chloride alone is not covered alone by part D as Sue said above. In any case it's relatively cheap at about 12 dollars a month with a good rx coupon.

oops I meant Medicare Part B

Mine is $47 a month for .3% hypertonic Saline. I just have so many other copays I’m just bitching. Over $5000 for the year so far. Hard to do any extra each month. And I don’t qualify for any assistance because of my income . Which isn’t much for 55 years of working myself to death.

Thanks , I have been think about switching to United healthcare. Simply for some meds reasons and my doctors at Shands is retiring and I have to find an Alpha-1 specialist and we don’t have one in North Florida under my plan. So.

Go to Walgreens and use good RX then it will be around $12 I think without insurance. I can get 3 months for maybe 20 (I forget exactly how much)