3% Saline vs. 7% for Nebulizing

@hopeful33250 @beejenigma @sueinmn I just went through getting my prescription for 7% saline from my usual pharmacy (Publix). They did submit to Medicare Part B and told me it was declined. I went home and called Medicare. I must say, I had no problem getting through and they were very helpful. They confirmed that it is covered under part b and called my pharmacy with me on the line to find out why it wasn't going through. It turns out Medicare covers it but Publix will not accept the Medicare payment for this prescription. I called several pharmacies and they all told me the same thing. Finally I called Walgreens and they told me they do accept part b. I am having my prescription transferred and will see if it actually goes through. So, it seems your doctor does need to code it as durable medical equipment but you also need to find a pharmacy that will accept part b. Whew, what a battle...for salt water! Imagine, no problem getting all of these other toxic medications but salt water is a hassle!

@beejenigma I'll try to explain why, based on lengthy study of the Medicare rules and a long discussion with my excellent independent pharmacist about how it all works.

Any medication dispensed via durable medical equipment (nebulizer) is covered by Medicare Part B. Many pharmacies seem to not be aware of this, and try to submit to Part D, which always rejects. (It seems that not every pharmacy is enrolled to dispense under Medicare Part B, but this is my impression.)

Saline nebs are considered an "adjunct treatment" not a medication. So if you have been prescribed a nebulizer and an inhaled prescription medication, when saline is also prescribed it can be covered. The pharmacy must code the bill correctly and submit to Medicare Part B. It also helps if the prescription for the nebulizer is in your Medicare records.

If you do not have any prescribed nebulized medications, it is unlikely Medicare will cover the saline. However, if you already use a prescription inhaler for your lungs, if the doctor prescribes the inhaled version of the same drug, then the saline, it will be covered. My doc did this - I normally only use an inhaler, but I have an "on hand" nebulized version of the same, for use during an exacerbation.

For those with a Medicare supplement that includes a monthly or quarterly allowance for over-the-counter FSA eligible products, the saline solution meets the requirement.

@sueinmn I will ask the hospital pharmacy about this but you would think they would have known that being as they are the hospital dispensary. I will ask. Thank you

@mjb24
Will you post and let me know if it is covered and what kind of results you have using it?

@beejenigma Hospital pharmacies by default are set up to cover in-patient medications, which are billed/handled differently to out-patient costs. So there is not the same awareness of what is covered and how to code.

Walgreens varies by pharmacy - this story dates back a few years. My prescription was covered there. My friend was not, for the reasons I explained in a previous post. My local Walgreen's pharmacist was kind enough to find a discount program and share the information with me so I could help her get a discount. You might want to ask your pharmacist to "run it through" GoodRx and any other discount program they participate in to get your a discount. You are allowed to use GoodRx even if you have Medicare.

@mjb24 I was refused by Walgreen's. I have never found it to be covered anywhere.

@beejenigma @hopeful33250 @sueinmn Well I struck out with Walgreens. They told me "none of their 7% saline manufacturers are contracted with Medicare". I also tried using a Good Rx coupon at Publix which would have put 60 - 4 ml at $29 but they said the price was $51 with their discount. After some back and forth they offered a coupon for $45. So we can't count on GoodRX pricing either? This is ridiculous!

@hopeful33250 I have been using the 7% saline for almost 2 years now but getting it through private insurance. I just recently became eligible for medicare. I can't really say how it has worked for me as I have been using it for close to 2 years now and still no negative culture. I do think it helps with getting more mucus up.

@mjb24 I've been using 7% for 1.5 years, I test either negative or low count, always negative smear since nebulizing. Are you monitoring your counts? I send to NJH lab now quarterly and they do the culture counts.

I have Medicare Advantage and get my box of 60, 7% at Walmart for $4.

@kathyjjb wow. How can that be. I pat medicare AAnd B and G of 278 a month just for gap alone. Neb medications is supposed to be covered under B because of nebbing it. I pay like 60 on average for 7% no one seems to help with the cost. Its insane . Pay into Medicare yoir whole life but its hard to find out how to get things covered. Im having trouble just getting new nebulizer. Mine is very weak. Medicare gave me names if Walgreens 2 diff ones . One cvs. 2 DME . None seem to be able to get me one. This is a crazy world. The mayo is trying aftercrelentless calls and messages to them with all the info they need. But not one yet . Crazy . I need it desperately