Good Grief -Medicare Insulin Part B Dance

Does anyone know the protocol or requirements that Docs must reauthorize Insulin Refills and how often this re-authorization comes up?

I have 3 refills available on my RX…but pharmacy says Dr. has to complete a new form to reauthorize?

My Dr. office is not great on form completion so I want to make sure the pharmacy is correctly interpreting before I go down this road with my dr. office.

You have 3 refills available on your RX but what is the expiration date of the RX? The 3 refills have to be taken within a time-frame of 1 year in the US.

my RX says 3 refills before 02/12/2021

OK, there are a few other possible reasons but the best would be to ask pharmacy why they need re-authorization. The most common reasons are that your insurance no longer covers what you are on so they need a re-authorization or a medicare requirement, etc. but no point playing a guessing game when it is so much easier for you to ask the pharmacy.

Thanks for the feedback and suggestion. I will check back with pharmacy again.

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FYI - Talked to different pharmacist who told me Dr. determines pre authorization dates, then pharmacist called me back telling me he called Medicare to do an “override” to permit the refill of the insulin. It’s still all a mystery to me…and thanks again for you support.

@jjpkring:

It sounds as if you are making progress now. Hooray!

Like many here, I struggled to get my insulin under Part B Medicare. Even though I now get that filled regularly, I’m not sure that I can recite the rules and restrictions.

But here are a few things that I HAVE learned that, I hope, may be of help:

  1. In terms of percentage of prescriptions filled in any retail pharmacy, a Medicare Part B for insulin is a real rarity. As a result, there is a HIGH probability that the pharmacy tech and/or pharmacist doesn’t know how to handle this properly. When you DO find someone that knows what they are doing, try to work with that person.

  2. Once you have a prescription in their system as Part B, refills usually are easier. I’ve had pretty good luck using the app that many pharmacies have for a refill.

  3. Make sure that your PCP or endo knows that they absolutely have to include that the insulin is for use in a continuous insulin pump. You would think that should be an automatic … but not always. I think that there are other specific bits of information needed … but I can’t remember them all. As I recall, however, @Dave44 created a good list on this forum of all the things you may need to provide.

  4. For reasons that I don’t fully understand, these prescriptions can’t be transferred to another pharmacy ( even in the same chain) if you move or are on an extended vacation.

Best of luck … I sincerely hope that you get to the finish line of this soon.

Stay safe!

John