Does anyone know whether Fiasp for use in an insulin pump is covered under Medicare Part B? I’ve recently switched from employer based insurance to Medicare + supplements and am hitting obstacles trying to get my scripts set up. I thought Fiasp was covered under the Part B/DME rubric, but I’m getting hit with a requirement for a CMN that the pharmacy says is unusual. Trying to determine if that’s why. Really prefer Fiasp and don’t want to have to go back to Novolog/Humalog…
I’ve used Fiasp in my pump off & on for a couple years now, paid for by Medicare Part B. No out-of-pocket cost. But it usually takes about 10-14 days for the pharmacy to get the OK to fill it. Most of that is pute laziness on the part of the pharmacy staff who don’t want to call the Medicare office.
But…I have the problem that Fiasp flat out quits working after two days - which may actually be after a certain number of units are used. Your mileage may vary. In my case, I just change everything every two days. But good luck getting M’care to allow the xtra cartridges.
Don’t know about Fiasp being paid for by Medicare Part B. But I’ve read that Fiasp tends to clog inset/tube mechanisms after about 2 days.
I change insets every 2 days because otherwise I get a rash. Had no problem getting the extra insets through my CDE’s prescription. Medicare did not hassle. I get my supplies from CCS MedicalSupplies.
I’m getting FIASP from Walgreens with Medicare as insurance. The CMN is justification for specific insulin, in this case FIASP and is filled out by the provider. Starts faster/clears faster allowing me to meet treatment objectives worked for my CMN. The Rx has to have a bunch of things, including, pump model/serial number, daily insulin dose, pump settings and number of vials and interval. I also get asked about insurance the pump was acquired under, a little complicate with a free upgrade and recall replacement. Maybe other information required, I don’t remember. Important note, Rx can be filled for more than calculated from daily dose. I use just over two vials every 90 days, but get 4 vials every time. The extra vial let’s me build an emergency cushion and cover a months delay. New Rx’s, first and annual, are by far the most difficult to get filled.
Ugh. I’m already into my zombie apocalypse insulin stash, which is actually past expiration though it seems to be working ok (I used up my current ones in the time it has taken for moving to a different state, changing over from employer-based etc etc). So this sucks. What’s been truly absurd and ridiculous is all the contradictory info I’m getting from all my phone calls to Medicare, my medigap insurer, my pharmacy, my dr’s office around how to actually go about getting the prior authorization done and where it’s supposed to go. Medicare effing told me “Oh, we don’t keep PA’s, that’s the pharmacy’s job”! What??? I think they meant the DME service, which does maintain that stuff, but you can’t get insulin from a DME service (at least not from the one I use) even though it’s for a pump and therefore DME. Aggggh!
As far as other problems go, @Willow4 I’ve been pumping Fiasp for quite a few years now without any clogging or other issues, so lucky me . Thing is, all my settings and calculations—especially the off-the-cuff ones for stuff I eat all the time—are based on it. So I really want to stay on it, and I hope that’s sufficient cause for the Cert. of Med. Necessity, as Medicare calls it. But this whole switch from private employer-based to Medicare+supplements+supplements+supplements has been a nightmare.
@DrBB, I do believe that your health practitioner is at fault here. I have never had a problem getting any of the Rxs through. Now this is predicated on you being a T1. Unfortunately, the sailing is not as smooth for a T2. My CDE’s office help is very good at getting these things through. That is not true in all health practitioners’ offices.
Latest from my Endocrinologists:
I wanted to let you know I have been working on this all morning and spent an hour on the phone with Medicare. They are telling me the doctor is not authorized to bill under DME (only part A, B, D, etc). I am trying to determine if this is true.
Aggh. In other related news, it turns out that past-expiration insulin really doesn’t work as well as unexpired. Who knew.