Is anyone else having difficulty in refilling prescriptions for insulin used in an infusion pump, billed under Part B, Medicare? The mail order/home delivery pharmacy I used refused to place the order, as did the local Walgreens.
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The cyber attack was 4 weeks ago, most services have been restored and what hasn’t been restored has long since been converted to operating on emergency procedures.
I see on reddit that last week Walgreens employees were still not able to bill Part B. Dunno why inability to bill is affecting their ability to fill. Got any other pharmacies in your area that can do Part B like CVS? Ask them if they can fill it.
While I agree with @spdif on what has occurred with most of the issues, I filled a test strip scipt at the local Walgreens this week. I had business with them as I got a Walgreens check apparently reimbursing me for the co-pay for strips I got last August a week ago. Walgreens wanted to charge me the same co-pay for this weeks order and I brought their attention to the fact they had just reimbursed me the same amount. The pharmacist stated the hack was still impacting their system’s ability to interact with Medicare’s so Walgreens policy was to still charge the co-pay. Perhaps something like this is impacting your script?
Thanks for this. The Walgreens’ pharmacist suggested transferring it to CVS but I declined when I was there this afternoon. May reconsideer. Means a trip to CVS first…really becoming annoying. Luckily, I’m not down to the last bit of insulin…but still, will this become the norm?
Again, thanks.
Terry
I get mine through Walgreens via in-person pickup. Took me a while to get this figured out. Caremark glitched on it because they don’t do DME and they had no idea what I was talking about, and likewise my local Walgreens at first because they’d never heard of insulin-as-DME either. Eventually we figured out that it has to be done through Walgreens’ Medicare Benefit Manager, who does the handshake between your doc and Medicare, certifying it’s for a pump and that it’s been less than 90 days since your last appointment. Turns out you have to jump through this little hoop each time you order—it isn’t a one-and-done. Now I know that, I call Walgreens a few days ahead and it’s been glitch free since then.
It was fairly amazing how hard it was to get this information! I just figured the doc or the pharmacy guys or Medicare would know all about it—it’s their business after all, and I’m hardly the only person in the world doing it this way. But nope.
The answer to this gets more into IT, business, economics and government than I think we want to get into on a diabetes forum. Concentrating just on getting insulin… Walgreens, like RiteAid before it is struggling financially They can’t afford to staff their locations to meet demand and will be closing 10% of their stores this year. We need to choose companies we can trust to supply our medications reliably and many times that means a less convenient option. Then always have a backup plan of another company you can use.
Personally, I use mail order because I’m on a commercial plan and it is cheaper. It was affected by the cyber attack but recovered in less than a week. I have a local pharmacy that I use for the occasional stuff and can backup my mail order pharmacy. There’s another local pharmacy in town that is plan C. Plan D was Walgreens, after this its CVS or maybe a grocery store pharmacy that has time to take care of their patients.
I was looking for this information for Terry because people keep talking about it but never say what phone number they are calling or phone menu option they are choosing or what they are saying to the person at the counter that makes them go “oh that procedure”. @DrBB would you be willing to share exactly how you are getting this done? And just to double check, have you refilled your prescription since Feb. 21, 2024 when the cyberattack on Change Healthcare/Optum/United Healthcare occurred?
Exactly describes my bafflement when I started trying to figure this out, so I’ll try to be more granular. There’s no automated way to do it. It starts with you presenting the script to the Walgreens pharmacist, explaining that even though it’s a drug it’s eligible to be covered as Medicare Part B as a pump component, but to do that they need to contact their Medicare Manager to okay it. Manager contacts your prescriber and Medicare to certify that it’s for an insulin pump and that you’ve had a visit within the statutory 90 days. Medicare okays it and voilà it shows up as accepted for payment with zero copay on the Pharmacist’s terminal.
Hope that’s clear enough. I have no idea how other pharmacies handle it but I’m guessing more or less the same. I made absolutely no headway on this until I finally got a pharmacist who at least knew to ring up their Medicare Dept, after that it was relatively smooth sailing.
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Thanks for this. I’m still working on it. I’ve inquired from the provider of pump supplies and CGM whether they also can fill insulin prescriptions since Alliance Rx-Walgreens (their mail order/home delivery service) seems confused. They did supply insulin in 2023 after much back and forth, the latest order being in Nov 2023. I think the insulin cap amount legislated recently has added to the confusion.
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Main thing I found was that the mail-order houses don’t do DME, so when you talk to them about processing insulin as DME rather than a pharmaceutical, they think you’re speaking Klingon. They can’t process a pharmaceutical as DME because DME codes don’t exist in their system. Only way seemed to be to go to an actual pharmacist and have them contact their Medicare Manager. That was the first point at which I encountered—by proxy—someone who was familiar with this and knew how to do it.
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Yes, Apparently the entire US pharmacy system, except Walmart, was attacked and is having to pay ransom. The pharmacy should fill the prescription for 1 month at $70 and pay you back when they are able to rebill under part B.
Thanks for this. I think the basic problem is the pharmacies try to bill insulin under my prescription plan (Medicare Part D), rather than as a Medicare Part B benefit – durable medical equipment. The pump won’t work if there’s not insulin in it. Last year, I’d finally gotten Alliance Rx-Walgreens (their home delivery/mail order entity) to correct bill. Also, it befuddles pharmacies that I do not have a co-pay for insulin unless I’ve not reached my annual deductible (which I have). Medicare Part B pays then my Supplement plan pays the balance – up to $105 for a 3 month supply.
I filled my DME insulin last week but was charged for the vial. Pharmacist said that Walgreens would reimburse once things got back to normal. I was there today and requested the pharmacy manager to submit the request for reimbursement. He checked with corporate and yes this is the process. Walgreens will not automatically initiate the refund, but will wait for the patient to ask their local pharmacist to request the refund. Not exactly customer friendly.
The problem with getting your insulin probably isn’t because of the cyber attack but because "Drugmaker Eli Lilly warned this week that two of its formulations of insulin would be temporarily out of stock through the beginning of April, citing a “brief delay in manufacturing.”
“The 10-milliliter vials of Humalog and insulin lispro injection will be in short supply at wholesalers and some pharmacies, Lilly said in a statement posted online Wednesday.”
Thanks for this. I had read about Lilly’s announcement. The mail order pharmacy, Alliance Rx-Walgreens, continued to say it was the cyber attack. I contacted the Washington state health insurance benefits admunistration, known as SHIBA, am expecting a Fed Ex shipment today.
Terry
I worked with the Washington State Health Insurance Commission and they called Alliance Rx and now I’ve received a shipment notice with a tracking number and am expecting the 90-day supply tomorrow. I only hope I don’t have to go through this every 90 days.
Thanks for responding.
Terry
You did a good job of making your legitimate need as a patient known in a way that brings pressure to bear on the responsible parties. Too often, it is the patient who suffers most of the ill effects when the supply logistics fail.
Well, it’s taken weeks and umpteen phone calls, emails, and frustration. It shouldn’t be like this. At least I have 90 days now until I have to do it again.
Terry
I’m with @Terry4, great job holding Walgreens accountable for their failure and getting what you needed.
I saw on reddit Walgreens might have finally fixed their ability to process Medicare Part B claims 2 days ago.