Does Medicare Part B cover sodium chloride solution?

If it is an inhaled medication, and you have prescriptions for both the solution and a nebulizer, it is covered under Medicare Part B. Prod them! CVS and Walgreens have both covered mine. You pay 20% - my last charge was $8 and change for 60 vials.
Sue

I'm facing this as well, was turned down. I bought a nebulizer from Amazon so may need my ID doctor to prescribe a new nebulizer. Thanks for the heads up!

Sue,
I don't believe sodium chloride is considered an inhaled medication. Is it? In the NTMir discussion group, someone said Medicare B covers her prescription for sodium chloride only if she picks it up along with her prescription for abuterol. If you asked only for the sodium chloride, she has to pay out of pocket. Are you saying you've been able to get CVS and Walgreens to cover just the sodium chloride? And do you know what Diagnosis Code your doctor has sent to CVS? Maybe my doctor is using the wrong code.
lora jo

Yes, I just picked my latest order up at Walgreens a couple weeks ago. My pulmonologists have been prescribing it for almost 3 years now.

That's great, Sue. Can you ask your pulmonologist for the Diagnosis Code she/he sent to Walgreens? Perhaps that might work for the Walgreens out here in the SF Bay Area.
lora jo

I'm sorry you are having such issues. I know from past experience that my medical group, by policy, does not release diagnostic codes to patients. If it helps, I have NTM, Bronchiectasis, asthma, chronic overreactive airways and allergies. I really think your next "stop" in solving the puzzle should be your insurance provider's formulary - to see if 7% saline is listed. Then contact their customer service.
I hope you can get an answer. May I ask what your cost would be without insurance coverage?
Sue

Hi Sue,
That's very curious why your doctor won't provide a Diagnosis Code to a patient. I have spoken to customer service at my insurance company and they say sodium chloride is not covered by Medicare Part D but says it is covered by Medicare Part B. So I tried with both CVS and Walgreens but they both say it's not covered under Part B either. When I was with Kaiser, my co-pay was $8 for 30 days of sodium chloride solution. I am now on original Medicare with an Aetna prescription plan. I had to pay CVS $26 out of pocket with Goodrx coupon for one moth's worth of 3% solution. My doctor's office worked with Walgreen's and got it down to $11.50 for one month. If I can continue getting the $11.50 per month price, I might stop wasting my time trying to get Medicare Part B to pay for it.
lora jo

@lorajo
it’s my understanding that Medicare part B pays for it provided it’s used in a durable medical apparatus of some sort like a nebulizer. I would call Medicare 1-800-MEDICARE and ask them. There are a number of medication’s that Medicare part B does pay for and I believe this is one of them.
Good luck,
Jake

Thanks, Jake, I will call Medicare on Monday.
lora jo

In reply to @ljfoo … in my case, it took a number of attempts to get the 7% solution covered by pt. B. What ended up resolving the issue was having the pharmacist call my pulmonologist’s office and walk them through how to submit the script in the way needed for Medicare. It finally worked and has worked for the past two years now! This is another idea to try. Good luck!