Hi everyone, this is my first blog - has anyone found an insulin supplier who bills Medicare Part B directly for your insulin? I am a new pumper and I cannot find any insulin supplier who accepts Part B. This defeats the whole purpose of Medicare allowing insulin to be considered part of the pump and therefore not charged with a deductible nor added to Part D yearly medicine rates.
So far I've called 30 suppliers listed on the medicare.gov site; I've spoken to 3 medicare agents plus a manager - this was disappointing because they are not aware of the rules nor could they supply the name of any insulin suppliers who bill Medicare directly. I've called the corporate offices of Walgreens, CVS, and Target - no luck. I've called Eli Lilly and spoken with 3 different department heads but no luck. The answer I was given over and over again was that the suppliers will not bill Medicare Part B because the reimbursement is less than the cost of the insulin. This seems like a very bad joke that allows Medicare to say that it is dramatically reducing the cost of diabetic insulin for seniors by not providing any supply to the patients.
I have not given up yet. If anyone, anywhere in the country is currently billing through Meidcare Part B then please send me the supplier's contact information. Thank you, Susan
I believe almost all pump manufacturers supply part D eligible pumps. I for one am a Part B participant, and just this year received a pump from medtronic. Now you do have to go through a doctor but one has to do that with any pump manufacturer at any time. All pumps require a prescription.
Rick,
Thank you for your comment. However, I think that I did not clearly explain my dilemma. My Tandem TSlim pump was prescribed by my doctor then it was paid for by both Medicare 80% + 20% paid for by my supplemental insurance. The problem is that under Medicare Part B rules the insulin used in the pump is considered part of the pump and is not to be charged in anyway to the pumper. See the Medicare rules at the link below plus the details:
Insulin Pumps and the Insulin Used in the Pumps
http://www.medicare.gov/Pubs/pdf/11022.pdf Insulin pumps worn outside the body (external), including the insulin used with the pump, may be covered for some people with Medicare Part B who have diabetes and who meet certain conditions. If a beneficiary needs to use an insulin pump, their doctor will need to prescribe it. In the Original Medicare Plan, the beneficiary pays 20% of the Medicare-approved amount after the yearly Part B deductible. Medicare will pay 80% of the cost of the insulin pump. Medicare will also pay for the insulin that is used with the insulin pump.
Thanks again, Susan
i get my insulin at rite aid & both medicare & secondary insurance pay for it
but i get a prescription for it
Shoshana, thank you very much - I will contact Rite Aid tomorrow and will let you know if I am successful. Thanks, Susan
one more thing, be sure to sign up for a perscri[tion drug plan and a supplementl part B plan if you can i realize people under age 65 are often held out of the supplemental plan. Good luck i know this is a tough situation.
susan, glad i could help, hope it helps.
Susan...I too get insulin for my pump from Rite Aid. At first they wanted to charge me but I insisted that was incorrect and they got it straightened out and now I do not pay for my insulin. I think it is charged under durable equipment but not sure. I do have a part D supplement but they do not pay anything for my insulin at least that is what they tell me. Hope this helps.
Susan,
I know this discussion is a year old but I'm in the same situation. Did you ever find a supplier for insulin in a pump?
I'm also having trouble trying to find a supplier, for my t-slim pump supplies, that will accept Medicare assignment and my Medicare Supplement(Medigap).
I've contacted Tandem and their having trouble finding me a supplier.
Who did you get your t-slim pump through, I read above that yours was covered 80% (partB DME) and the 20% (Medicare Supplement).
I'm having the same trouble. I've been using Edgepark but starting in 2015 I'm on medicare and Edgepark is no longer a medicare supplier for tandem/pump supplies. It looks like Edwards Healthcare is. But where else, and which is a good supplier? Anyone with any experience out there?
Susan,
This has been a real hassle, both for my Tandem pump supplies and especially insulin. I too spent weeks to find a supplier and it was incredibly hard and have been trying to get my pump stuff from CCS Medical who supposedly says they can do Tandem and test strips. But they no longer will do insulin because "we stopped supplying insulin because we can't make enough profit". I'm currently off the
pump because I'm out of both pump stuff and test strips because they can't seem to get it shipped. They send my phone calls to voice-mail and rarely call back. Even when I do get a call or email reply there's always an excuse.
On the bright side I did get my insulin through a local pharmacy where I personally know one of their billing people who finally figured out how to get "insulin for pump" covered under Medicare DME. They only do this for two of us pump patients in our small town. They told me that they get a very slim profit margin and only do it because I buy my regular Rx's from them so they consider it good "customer service".
I bet suppliers are so used to exorbitant profit margins there's easier ways to milk the system without having to deal with us (Medicare) smaller profit people. In 1971 I bought Regular insulin for $1.11/vial It was on sale if I bought a case of 10 or 12 vials, even off sale it was less than $3. I just priced out 1 vial of Humalog through my Part D coverage it is: "Total Cost $610.02 and Your cost $378.00". Granted my Regular insulin in 1971 was pork based and Humalog is definitely better and faster acting but they do the similar job, in fact I continued using Regular in my pump even after Humalog came on the market. Big Pharma and Insurance have really got it figured out, in this country, and put the screws to us! We're just their cash cows.
Good luck trying to get this worked out, it's incredibly hard it's taken me months and I still don't have my pump stuff.
Any updates? I’ll be on Medicare as of June-2015 and am trying to figure out how to get insulin for my pump from a source that bills Medicare Part B … This is due to Medicare stating that insulin used with a pump is considered as DME and not under Part D (prescriptions).
Any pharmacies or mail-order locations? I’m in the Dallas area.
Cheers,
Nolan K.
I’d like to see if someone would explain how this works too.
I get both my Insulin and my Test strips free on Part B from CVS. They are an approved supplier, as I believe is Walgreens. It took awhile for them to understand that you can bill insulin on Part B if it is for a pump. Most of their older customers are not on pumps so they are used to it being different. What I had a major struggle with was getting them to bill my secondary insurance for the Part B co-pay. They are the only provider I know that won’t bill the secondary for the co-pay. So what I did was just make sure the co-pay is already paid in the early part of the year before I go for my insulin and test strips. Easy enough to do since one test or doctor’s visit does it.
I get my Medicare Part B insulin for my insulin pump from Walgreens.
Franco, can I ask the motivation for using R (not recommended for pumping, as it isn’t buffered like Velosulin) after Humalog hit the market in mid-to-late 1996?
Did you have issues with no-delivery? How many days did you usually wear your sets back then, and what type of sets? steel needle, or cannula type?
hi suzan
i get my insulin at rite aid
i never had a problem
I used R because that was all that was available when I started using pumps late in the 1970’s. Yes, occlusions were always a hassle. I did find out that my over the counter allergy med I was using would cause the occlusion within hours of taking the med. I assumed it was the antihistamine dried out my tissue and created a plug at the end of the needle. The only infusion sets at the time were a straight steel needle stuck in the end of the tubing, no wings. I inserted the 5/8" long needle in at an angle then I used adhesive tape with the method that nurses used to tape an intravenous needle into the arm. Eventually IV sets added plastic wings to the needles and the pump manufacturer used the children size IV sets for the pumps. The straight, taped needle was very irritating and easy to accidentally get ripped out or bumped and stabbed in deeper. One good thing was that I reused the tube/needle over and over again just wiping the needle with alcohol and re-insert it at a new location. One of the biggest improvement in pumps, other than size, was when the infusion sets were made specifically for insulin pumps with non-steel needles and insertion devices and self adhesive.
Phoenixbound,
Sorry I forgot to answer your first question for my motivation to keep using R instead of Humalog. It was mostly cost but also Humolog at first had not been tested in pumps so it was not recommended for pumps.
No problemo! I couldn’t wait to get Humalog, hence I must have been the first in my area as I kept bugging all of the chain pharmacies who kept checking with their suppliers. As soon as it hit one of their warehouses they shipped it to my pharmacy right away. I didn’t like pumping with Velosulin as it was too slow (like regular) so I was highly motivated to switch to something faster. I wasn’t concerned about “official rules” about which insulin to use as long as it worked. And we all know now that Humalog is fine in pumps. I’m a pragmatist–just give me what works. 