How should pharmacy process insulin under Part B with a Supplement? *UPDATE*

Type 1 and LADA
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Update: First, thanks to everyone for the help. You were invaluable.

I don’t have my money yet, but at least I know why Walgreens was unable to process my supplemental (Medigap) insurance, Sadly, they apparently still don’t.

Anyway, an experienced pharmacist was determined to figure out why the same was happening at his pharmacy and realized that my supplement insurance carrier (BCBS) did not have a contract with them. They could process Part B, but not the supplement. Walgreens is undoubtedly the same

Now I just need to contact BCBS to find out which preferred pharmacy they contract with and go there (sigh).

Annoying, but doable.

Now, as to the money… has anyone ever sent a demand letter to a multi-billion $ organization? Or sued them in small claims court? It’s been over six months. I’ve been patronized, lied to repeatedly, and dismissed. I’m p*ssed, I’m ornery and I’ve got time.

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I have original Medicare with a Supplement. I’ve been using a pump for years and received my insulin through Novolog’s patient assistance program, so I haven’t had to deal with pharmacies or insurance before.

I filled my first Part B prescription (90-day) at Walgreens in January. I was required to pay the copay ($105) even though I gave them my Medigare Supplement Card. The pharmacist said it worked that way and I would have to sort it out with BCBS. I needed the insulin so I paid.

In original Medicare, after Medicare pays its part of the claim, it forwards it to my Supplement insurer. This occurred, and they paid Walgreens $105.

Walgreens has now received $105 twice. I still haven’t received my $105 back, even after talking with the pharmacy several times. I’m told to be patient - the billing department will automatically send me a check. I’m still waiting.

Has this been your experience or is this a pharmacy issue?

Thanks,
Mimi

Edit: clarity

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I use Walgreens both in Minnesota and in Arizona and I have never had a copay for my Part B insulin. Here is one of the numbers for the Walgreens national Medicare department and maybe someone there can help you. (888) 281-0590

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I will give it a try. Thanks very much

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I have been on Medicare for 10yrs. I get 9 vials of insulin every 3 months for my pump. Not sure exactly why but it is always a struggle to have the prescription filled. It usually takes a week. I realize pharmacies are at times short staffed and they now have to deal with vaccinations etc, but i am not sure all pharmacists are familiar with the process of billing Medicare Part B. Most times I have to call the Walgreens 1-800 helpline to complete the order. After each refill I say to myself, I have to find a new pharmacy but never have.
The last time I tried to have it filled I was told that Medicare Part B was hacked and they would have to bill it through my Part D plan. They told me the copay would be $105. Since I try to keep a minimum of 3-6 month supply on insulin on hand I declined. I waited 2 weeks and was able to have them fill it through Part B with no copay.

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I’m sorry you are having problems too.

I’d heard that the Part B processing system was completely down for a few weeks. That’s what they may have been talking about.

Walgreens really, really wanted to run it through my Part D. Easier for them, but $35 a month I shouldn’t have to pay, especially for the convenience of a company that made several billion in profits in 2023.

Is there a Medicare rule requiring the use of Part B over Part D when eligible? I think I recall reading that somewhere.

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I have Medicare advantage through UHC. Just switched from MDI to a tandem pump. I really thought my insulin would be covered under part B but it is not. I think Medicare made changes in 2023. I checked with insurance and chapter and Dr Google. I remember years ago it was covered. Maybe they figure the $35cap is enough. One hand gives and the other takes.

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Hi Jane - thanks for responding

I’m on original Medicare so not sure how things work with Medicare Advantage. I hate that there are so many different systems and rules to follow

For original Medicare they still cover insulin for approved, tubed pumps under Part B DME. They sure don’t make it easy to figure out.

The “Maximum You May Be Billed” is the part that was paid directly to Walgreens by my Supplement insurance company. Medicare automatically forwards the claim to the Supplement insurance company after it pays its part

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I agree. Should be same throughout Medicare insurance. It’s peoples lives. I am an RN and so many people can’t afford the insulin they need to live. It’s an old drug. Should be 0 co pay. But just my opinion. Thanks for replying.

Jane Cerullo

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Hi @Mimi5 and welcome to Tudiabetes. Hopefully we can help you find a solution. I hope you stick around, I’ve been wanting to see a medicare claims statement like you posted for a while. Thank you for sharing it.

I found this note at the bottom of a Medicare Administrative Contractor help sheet.

Jurisdiction J Part B - Provider Refunds to Patients.
Each secondary payer has their own rules about refunds.

I think Supplement, aka Medigap, plans are considered secondary payers. So the rules for how fast Walgreens handles the issue may be up to your BCBS plan. I’m willing to try to search it if you let me know your state and specific plan name. Have you contacted BCBS about the issue or called the Walgreens phone number @Laddie provided? I’d be interested to know what they said.

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Hello @spdif and thanks for the welcome.

My Medigap insurer is BCBS of Alabama. I’ve spent quite some time on the phone with them and they’ve been great. Once we got past the “no, it’s a Part B medication because tubed pump, T1D” discussion everything was good.

Medicare paid their share then forwarded the claim to Medigap for their the copay.

Here’s an image of my BCBS Medigap paid claim where they paid the copay directly to Walgreens. Thought you might like to see that too.

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I checked the BCBS Alabama C-Plus Plan F and Plan G EOB’s and didn’t find any time limits that would help you.

Since BCBS won’t help and submitting a claim that will be denied then appealed and denied and appealed… and then approved is a lot of work I’d try the Walgreens phone number and see if there’s a record of your request for a refund and ask what Walgreens policy for refund time. Also ask if there is a way to expedite given that your store has been giving you the runaround.

Personally I’m feisty and have too much spare time at the moment. If phone calls don’t produce any hope I have no problem going down to the store and letting them know that I’ll wait while the call the medicare number to find out how to process the refund using my nicest bless your heart voice. If you do go this route I think its important to know their side. Read reddit.com/r/WalgreensRx/ how do you bill for medicare? and empathize with the kids behind the counter.

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Hi I have Medicare part b and for 9 bottles of novolog (there generic version insulin aspart) I pay $105 for a 90 day supply this is at cvs pharmacy. Please tell me how you get by with no copayment, I would love to save some money. Thanks Al

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Hi @Al13

Do you have a a private Medicare Supplement (aka Medigap) policy? It pays some of the out-of-pocket costs that original Medicare doesn’t.

I bought the BCBS of Alabama policy when I became eligible for Medicare. I also have Part D which I use for regular prescriptions, but not for insulin.

Hope this helps

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@spdif

BCBS sent confirmed payment to Walgreens for both claims and provided trace numbers so I think they have done all they can.

Like you, I’m feisty and have got some time so I’m not letting it go. In part because I’m stubborn but also because I don’t want other diabetics going through this. But I try to be careful in my interactions because I remember my retail jobs. And customers have become so much worse.

I’ll try the national Medicare line again with the trace numbers. Maybe it will work.

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Bump

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@Mimi5 Any luck getting your money back? I just had a terrible, horrible, no good, very bad call with my dexcom supplier’s customer service. Because they’re small I managed to get everything sorted but it was adults acting like middle school kids for a while there. While coming down off the ceiling I realized we hadn’t heard from you.

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Hi. Thanks for asking. I did get my money, but they certainly didn’t make it easy.

In July I sent a very professional demand letter to Walgreens Boots Alliance’s corporate representative in Illinois, with copies of emails, dates of calls, etc. and requested payment within 10 days or I would assert my rights in small claims court.

Two weeks later I had a check in hand for the amount owed. One small win, but I’ll cherish it.

And your description of adults acting like middle schoolers is so true. I have two grandkids in middle school right now and the resemblance is amazing lol.

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Walgreens is a mess. I was told repeatedly that Lyumjev was not covered under Part B and they were putting it through Part D. This year my part D plan refused to cover it because it goes in a pump. After two days of continuous phone calls I was told by Walgreens Medicare department that Walgreens was unable to bill Part B for Lyumjev., Humalog yes, Lyumjev no. I needed to go to another pharmacy. I had my dr send Rx for Lyumjev to CVS. They billed Part B with no problem. However they made me pay the $105 copay. I told them they would get paid twice. They claimed they wouldn’t so I paid it and thirty days later when I saw the EOB from United Health care I called CVS corporate, sent them a photo of the EOB saying they were paid and received a check in the mail within a week. This month when I had the Rx refilled at CVS, they did not charge me the copay.

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I have given up. I decided that I would think of it as a present to myself to not have to deal anymore with Walgreens. And, I took that prescription to the neighborhood independent pharmacy, where I get my heart medication, and paid $65 for 4 bottles of Insulin Aspart (aka Novolog). We just won’t talk about how they got to that particular price and amount for a prescription for 5 bottles for 90 days.

I was using the prescription that I had taken to Walgreens almost 3 weeks before. That I had actually asked for back, on my 3rd visit, and been told I couldn’t get it back, that I would just have to ask my doctor for a new one. (Which I could have done, with no trouble, I was in contact with the nurse about the whole ordeal). But I was trying to make it work.

Initial Walgreens visit: “we don’t have it in stock, we have to order it” and we’re going out to lunch. We’ll call you. 2nd visit, after no call all week: your doctor didn’t send the form for pre authorization to your insurance company, a new one on me. So, with the loud music making it hard to hear, I called the Walgreens Medicare Authorization number, went through my usual report of pump id and doctor visit date and got it approved, with no mention of this form being needed. So, this time, I’m sure the order was entered. A couple days later I got a text, saying the item was out of stock and I’d be notified when it came in.

Well, the following week, after having called Novo Nordisk and been assured there was no shortage (and that there was no way for them to tell where the problem was), I showed up again. A different clerk went and looked for the insulin and came back saying it was out of stock. Then, 2 pharmacists who obviously now recognized me gathered around, and said they didn’t know why it hadn’t come in, that they didn’t get told that and had no way to ask. I said something about my need for it (I had ordered while I still had an extra bottle, but at this rate …), and I was offered a sheet with listings of stores in the metro area with insulin in stock. (and refused the return of the prescription)

The visit to the next store on the list – which it turned out only had 2 vials, anyway – involved going through the Walgreens Medicare Authorization again, and the woman there saying it wouldn’t work because my Medicare number was wrong even though it had worked at the previous store. She insisted I call Medicare, but I had tried to call Medicare about the questionable pre authorization form and never reached a person. She later actually phoned me to say she had gotten it to work, after I had gone home, and authorized it again for the first store, where, of course, they didn’t have any of the insulin.

So, I went back, to the first Walgreens, 2 days later, 17 days after bringing the prescription, and asked if the order had come in. No. And the pharmacist brought out that original prescription, that I had been told the previous week I couldn’t get back, and asked me if I wanted it. I guess we were mutually glad to part, me and Walgreens. All the employees were pleasant, at least, and some had seemed really interested in trying to help.

I did actually try taking that prescription to the pharmacy that my husband uses at our regular grocery store. I don’t think I can even remember all the reasons that pharmacist had to not fill it, just absolutely not possible. I know that when I, years ago, first tried to get insulin covered under medicare part B, an independent pharmacist had assured me that no he couldn’t afford to do it, no independent pharmacist could (he’s the one who originally pointed me to a Walgreens he’d been told was good about Part B. And Misty the Pharmacist greeted the problem with interest, as of a challenge. She even made the calls for me! But, alas, she soon transferred (to a specialty pharmacy on the other side of the city), leaving me to have to convince each replacement that it was possible to do, and then teach him how to do it, again and again. And the whole idea of Part B had been very strongly rejected by my local CVS pharmacist years ago, and, though I had gotten it filled once by a young pharmacist in another CVS, her boss vehemently rejected the idea of a refill, as she stood red-faced behind him.

So, Part D it is. If they start saying it has to be Medicare Part B, I do sometimes go out of the country?