Insulin for pump through Medicare


#1

I have been on Medicare for 5 years and have been getting my Humalog for my pump from Walgreens every 90 days. The last 2 times it has taken almost 2 weeks to get the insulin from the local Walgreens.
Even though I have been refilling it every 90 days, it’s almost like starting over with all the info they are asking. Name and serial number of pump, diagnosis code, how many times a day I test, etc etc etc.
They also will not accept a fax refill. It must be electronic or hard copy.
Not sure if it is Walgreens or Medicare that has changed. Has anyone else been having this problem?
Thanks
Ed


#2

My wife had the same problem - got it for 5 years then had to submit paperwork again 3 months out of 5 -

one time they claimed the new SS# could not be used and the old one had to be used - then changed their minds again - then they claimed the form was not the latest one even thou it was identical

These pharmacies have companies that are between them and medicare (I COULD BE MISTAKEN) and one hand has no idea what the other is doing

so you are not alone -

GL


#3

Sometimes I get my 90-day insulin with no problems. Other times it seems to be a problem. This time with Walgreens they requested that my endo submit a new prescription although I don’t see why it was needed. And yes, they requested that it be electronic. It was also requested that it include the diagnosis code and specify units per day in an insulin pump. I did not have to give the info again on type of pump, serial number, etc.

Part of my problem is that the first pharmacist who tried to handle the prescription didn’t understand what he was doing and sent a formulary exception request to my doctor. He didn’t have a clue despite what I kept telling him. Fortunately I then spoke to the pharmacist who understands Part B and she has her assistant got it figured out. It took 5-6 days to get it taken care of. I’ve never had a 2-week delay.

But for sure Part B insulin is an adventure every 90 days. I think that most of the problems happen on a pharmacy by pharmacy basis and do not reflect a change in policy. In Facebook a few people have mentioned that the pharmacy would only give them a 30-day supply and was told it was Medicare policy. But I had no problems getting a 90-day supply. So sometimes I think “Medicare policy” can be a synonym for “I don’t know how to submit the claim properly.”


#4

Pumpers can get their insulin through Medicare Part B.


#5

I think we are bemoaning the sometimes difficult process for getting our insulin under Part B. My guess is that 99% of the insulin that pharmacies process goes through Part D drug plans or private insurance plans. Many or most pharmacy techs and pharmacists don’t understand it or know how to process it. Just because one got Part B insulin easily 3 months ago doesn’t mean it will go smoothly this time.


#6

I realize that, I have been getting my insulin through Medicare part B for the last five years. It’s just that the last six months it’s been more difficult and it takes about two weeks to receive my prescription. Not sure if Medicare part B is being difficult or Walgreens?


#7

Part B seems to stymie ALL of the pharmacies. I speak from experience with the following having issues with Part B:

  1. Safeway
  2. Walgreens
  3. CVS in Target.

the last time they were confused I brought in a hard copy of the Medicare rules. sigh. They begrudgingly agreed that they could indeed process under Part B but needed a script written for it. this stuff shouldn’t be this difficult.


#8

I get 9 vials of insulin (was Novalog until I switched to Fiasp six months ago) every 90 days for about 8 years through CVS/Caremark without any issue at a $50 co-pay.

Not sure if they use part B Or D, but I don’t care as long as I continue to get it on a regular basis.


#9

That’s the topic - tell a pharmacist to bill it under part B and they look at you like ET landed in front of them.


#10

Yup, some of them do which is why I brought in a hard copy, Tony. Upon persusing what I showed them, they indicated that they “should” be able to comply with a Part B Rx. Good god, what is so hard for the pharmacists to comprehend about insulin and Part B (pumpers) or strips and Part B? It’s not like there are only a couple of hundred pumpers or IDD’s on the planet. They should be dealing with this stuff every day.


#11

I had the same issues with the pharmacy when trying to fill my novolog prescription thru part B. I now just get it at the same Kroger Pharmacy and they finally started working with my doctor and got the prescription filled. I get 9 vials every three months and I’m due for a prescription fill when we get back north from Florida. Hopefully again this year I won’t have any problems.


#12

I have also been on Medicare for almost 5 years. I have been getting my insulin through part B and Medicare plus my supplemental insurance. At my last refill through Walgreens, they said they can only give me a 88 day supply??? They also want a completely new prescription from my doctor and who knows what else they will ask for. It is like starting all over again and it seems like I am asking for a ‘controlled substance’ instead of insulin. Why is everything getting to be such a problem?


#13

How do they do 88 days - confused I am


#14

Walgreens did that to me with my test strips. quite bizarre but they explained the math to me. Then I “got” it.


#15

Can you explain your understanding of a 3 month supply being 88 days? I don’t get it either.


#16

True, I think it depends on the pharmacist.


#17

Walgreens called today. They said they could not fill the prescription for insulin because my last doctor visit was 91 days and you have to see your endocrinologist every 90 days.


#18

Sorry, it’s been quite a while since they explained it to me, but I forgot the details.


#19

That’s ok because it looks like I am in for another ‘struggle’ with my insurance company to be able to use Novolog instead of Humalog which doesn’t seem to work as well for me.


#20

“it depends on the pharmacist” - it certainly does. I went into a pharmacy looking for the wipes that help remove infusion tape. He didn’t know of anything like that but recommended I get some “Goop” from the hardware store???!! (The stuff I use to remove dried paint, etc., from stuff.) Elsewhere I got some Uni-solve for this purpose.