So, after I last “talked” to some of you, I move my Dex RX to Adapt and got everything done in half an hour. I filed a feedback email with Walgreens. The problem store called today and said Walgreens has their own Medicare dept and it takes longer to get Part B like sensors from them because it’s not the same channel other suppliers go through.
True or no? Anyone have any idea???
True but the problem wasn’t that it took too long. They were saying you were denied because they were running your old insurance. Did they take any responsibility for their mistakes?
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They too k no responsibility for running the wrong card, they didn’t apologize for not returning my calls. They also said they take longer because they have their own department for Medicare and approvals take longer. She said they told me on the phone, but they didn’t. And she said when we did the three way call where Medicare called them and wanted me on the line, that Medicare didn’t realize things had to be run through Walgreens Medicare department. To which I responded that they never mentioned that to me or Medicare.
So I got Medicare labeled supplies from Adapt and they did the order in 30 minutes or less. This was going on nine days. Plus they said they might need more paperwork from my CDE who had already sent things twice.
Sounds a bunch of excuses to me.
We have no Walgreens where I live but we do have a WalMart. They gave me the same runaround that you got. I found a small pharmacy in town that was happy to handle Medicare Part B Rxs. I think that Part B pays less to the pharmacies and the large ones don’t want to bother with running Rxs through Part B because of it. If Medicare has a program, then I believe that ALL pharmacies should HAVE TO use it for people who qualify. Apparently they don’t. None of the government programs seem to run logically. Pity.
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Well said. I agree! And I tried to tell the girl, how am I supposed to know Walgreens has a Medicare department. All I did was call national Medicare and spoke to DME supervisors. That should have covered everything.
“That should have covered everything” is naive.
Ignorance of how a federal agency works is understandable, but that doesn’t change what they can do by law or make you eligible for services that Medicare doesn’t provide.
Federal agencies don’t do things because they “should”. They imperfectly do what they are authorized and funded to do according to their charters,
Medicare is an insurer. Medocare can’t provide or help get medical services.
Talking to a Medicare employee can only help you to understand your financial coverage and with processing your claims. It has no control over who provides consumer medical services or how those services are provided. Other Federal and state agencies have authority over those. Medicare has limited, indirect, financial control over the infrastructure of suppliers and distribution of supplies.
I didn’t know that Walgreens had a “Medicare department” for handling Part B prescriptions but it doesn’t surprise me.
My Medicare authorized “mail order” CGM and pump/infusion set supplier has a separate department. Medicare’s “paperwork” for Part B “durable equipment” for diabetes is far more complex than you could reasonably imagine. (They contact me long before my Rxs need reauthorization and request the doctor’s certification of my recent 4x/year mandatory visit. )
When I went to get my first prescription filled for my pump under Part B there was a week delay at Walmart because only one of the pharmacists had experience completing the forms for that coverage, and that pharmacist was on vacation. I got a copy of the arcane authorization forms and helped get them filled out.
I made a point of meeting with that pharmacist when they returned and found out more than I wanted to know about how Part B orders are processed. All Part B “durable equipment” and accessory items are distributed through a different channel to retail pharmacies, regardless of what pharmacy processes the orders.
Normally this adds 1-2 business days to the processing time but during the pandemic I had delays getting Novo insulin from Walmart, both Relion and Novo’s “normal” versions. There was a regional shortage during the pandemic and the much longer delays with Part B caused me to run out once. I had to revert to using the Novolin I had left over from my last pre-pump order.
Because of a two week delay I had with one refill order, when it came time to pick Medicare providers for 2023, I went to Walgreens and Osco to specifically ask them if they had experience with Part B insulin orders for pumps and whether they had any special suggestions. Both said that they had experience with Part B, but didn’t stock supplies for such orders. These come from a different distributor, and I should allow 10 business days to process the order - especially if it required a prescription renewal.
Medicare authorizes EVERY Part B order and because of the high retail cost the pharmacy doesn’t order the supplies until after they have the authorization. Medicare will not authorize a refill until the previous fill is nearly gone (in my experience that’s less than a week) . Medicare observes all Federal holidays and has an surge in orders between Halloween and New Year, as people try to take advantage of their insurance deductibles, and an increase in internal processing time after New Year when people switch to other supplement carriers.
Another thing I have to consider is that my endo is only “in the office” a few days a week, never in weekends or holidays So my Part B insulin prescription renewals can be delayed 5 days or more unless timed right - longer if the endo isn’t on vacation.
So unlike every other prescription I have, I order insulin refills by the
calendar, at 90 day intervals, 85 days after the previous order was placed by me. I call the pharmacy after 5 days to check in the order, and if necessary contact my endo’s office. ( Another physician in the practice or a PA can authorizes it, but won’t normally unless requested as an emergency need. )
My belt-and-suspenders solution to this uncertainty was to have my order written for slightly more than I normally need, long enough to build an emergency “stockpile”. This assures that I can handle unusual consumption due to illness, unexpected events like dropping a vial and breaking it, or having to go out of town.
I’ve been criticized, even ridiculed, for being overly-cautious about being prepared for worst case scenarios. Maybe I am a control freak, but I was paid a lot by my previous employer with 600 locations to prepare the business’ data systems to survive disasters like hurricanes, floods and earthquakes. Traveling 30 miles to work by train each day I became acutely aware of how vulnerable I also was to interruptions and service delays.
After experiencing the pandemic and seeing the effect of disasters in recent years, imo, every person with a chronic condition that requires a prescribed medication or device to preserve their life should automatically be provided with a 30 day emergency supply - ideally always near them, but always ready to grab and go at a moment’s notice.
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Obviously I meant it should be enough to have one agency not a Walgreens Medicare dept. I told her she needs to tell people that they have that division and things could take awhile. I moved my account back to Adapt Health and it was done in half an hour. However they have been keeping my records and asking how often I see my CDE for several years. I also saw this from Walgreens:https://l.facebook.com/l.php?u=https%3A%2F%2Fdrugstorenews.com%2Fwalgreens-debuts-medicare-billing-solution-enable-cgm-access%3Ffbclid%3DIwAR135HFeohOyGhx5l2si_A4n7ze2figCULHztzbVaojaOiI68tO3SDGGrCM&h=AT3Eymkk7B5rFgT2wfkWaizxrYBksjmu5tnTvQ529jVF1rBthp0fKHSw9f8hSKXlrVk0qBVfLO_6HdkgD73CDnMqYuLNlwfa6kmBQcnRjMVpH0B-RROhj5SGGWaYugGElYY
Word of caution about AdaptHealth. I have a Dexcom G6 and I got prescriptions filled and sent by AdaptHealth. Every year I had endless problems with the yearly prescription renewal. AH would fax the wrong form to the doctor, claim they were waiting for more information and I would have to make multiple calls to AH, doctor and Medicare when AH claimed some other information was needed from the doctor. Eventually discovered through multiple calls to AH that: they faxed the forms to the wrong doctor office location; they sent the wrong form that did not request the “physician notes”; finally received the form and the prescription was “in processing”; never received the Dexcom supplies. My doctor office said they had another patient getting DME from AdaptHealth and they had similar problems for that patient. Now I get both my DME, including a Tandem t:slim, from Byrum Healthcare. No problems with the latest yearly renewal.
Well that is how Walgreens handled my order. In processing for days, trying to get me a receiver I didn’t need and saying they might need more from my doctor after she sent everything twice. Now, I had my account at Diabetes Management and supply for my Omnipods for years, so they always asked at every refill if I had seen my doctor and they made sure to send her all my papers to do whatever was required. In fact when they got merged into Adapt, I wasn’t sure who Adapt was.
The other day they got my Dex ordered in half an hour and sent my one month supply. The Solera division pharmacy filled my pods and got me a 90 day. So do I get this Dex paperwork all settled at six months? For the Dex renewal? Would Medicare fill a 90 day order for Dex? That’s the only hassle I see is ordering every 30 days for that. It was much easier when my local pharmacy handled my Dex!
Laura,
I get 90-day supplies for both my Dex and Tandem t:slim. I never got a 30-day supply. However a few years ago my Pharmacy only did 30-day of anything.
But all pharmacies can handle 90-day supplies these days. Since these “DME” are used continuously, a one month supply barely lasts long enough for delivery of the next one.
When Medicare made CGMs and pumps Durable Medical Equipment, pharmacies could not handle them directly. So the few distributors, such as AdaptHealth and Byrum , get all the business. If the Pharmacy takes the prescription, they have to get it delivered by those companies. And the DME suppliers keep getting consolidated into bugger companies.
All the paperwork for DMEs should be exchanged directly between the prescribing physician and the supplier. The patient should not have to deal with it. Unfortunately AdaptHealth was not good about handling that interaction after they acquired Solera.
Mark
Well we’ll see how the end of November/early December Dex order goes. I will try to get 90 days. The Adapt Pharmacy person was really nice and said my Omnipod 5’s will be sent in a 90 day order. She got it all done and they’ve shipped or will soon. It was fairly easy communicating with their DME and Pharmacy divisions, so just have to see how the next orders go.