Can anyone with a tubed pump recommend a provider of insulin on Medicare Part B?
I’m new to Medicare and Tandem Control IQ, trying to order insulin and encountering weeks of delay. Insulin for use in a tubed pump is covered on Part B but Walgreens submitted my Rx to my BlueShield Part D, which was a mistake (they don’t deal often with tubed-pump type 1’s). They say we’re waiting for Walgreens Corporate to send the CMN form to my endo’s office, but tonight the pharmacist said: “your insurance is rejecting it.” How can Medicare Part B reject it??? I guess I need to call Medicare in the morning. I just messaged my endo office.
This is a maddening go-around for something on which my life depends.
This certainly can be a challenge. I’ve talked to many many people before I got the situation solved for myself several years ago. The Walmart pharmacy in my area which is Vancouver Washington is able to bill my insulin through my Medicare part B. I use a medtronic pump and the local rep wants told me that any pharmacy that can Bill Medicare part B for such things as a blood glucose meter has the capability of billing part B for insulin. Not all pharmacies are able to do this for some reason as they have to be authorized by Medicare to do this. She went to the Medicare website and searched for pharmacies in the area that could bill Medicare part B for blood glucose meters and told me I could deal with those pharmacies. I remember to originally get it all set up that there were many forms that Walmart had to help me fill out for Medicare authorization they even had to get a record of lab work from my doctor showing that a C peptide test proved that my body makes no insulin. I recently had a conversation with Medicare and amazingly the representative totally understood about Medicare part B paying for insulin used in an insulin pump. Perhaps they can be of some assistance to you in finding a pharmacy that will do it for you. If you have a Medicare supplement along with your original Medicare then the insulin should cost nothing when provided under part B. Otherwise there will be a 20% copayment. Sometimes in this case it ends up being cheaper through the part D coverage. It just depends on what kind of Medicare plan you have. I wish you luck.
Here in Arkansas I have Blue Cross Medicare HMO as my Medicare replacement plan and get a one month supply of insulin for $35
I use Walgreens (Denver, CO). They work with my endocrinologist. I order a 3-month supply. Every time I order, Walgreens needs visit notes from my last visit with the endo office. Per Medicare requirements, I need to visit my endocrinologist every 3 months. Walgreens also needs documentation of your insulin pump, when you got the pump and the serial number. It can be a hassle, but I do get my insulin free.