I think a fundamental problem with this system is that with so many people involved, miscommunication reigns supreme. With any Medicare prescription, the doctor writes/authorizes it, hands it off to a medical assistant who then sends it to a pharmacy. The pharmacists reviews it and a pharmacy technician is often involved. The pharmacy then communicates with Medicare, mostly to assure that the pharmacy will get paid once the medicine/supply is issued.
With all these people involved, I’m amazed when it works at all! On top of that, many doctor’s offices and pharmacies depend on facsimile or fax communication, a channel with its own risks and hazards.
I once had a Walgreens pharmacy tech tell me that Medicare would not approve my test strip prescription. When I pressed for further details, I discovered that she wasn’t referring to Medicare but to the national Medicare department at Walgreens. Once I applied pressure to this office, I was able to shake my strips free from the bureaucracy.
The only thing that’s worked for me is to over-manage the entire process. I check and double-check to see if communication that’s claimed to be sent is actually received. I keep notes and I am relentless in my follow-up. Sometimes I think people satisfy requests just to get rid of my nagging. Unfortunately, out of all the many people involved in this process, I am the only one who suffers if a medication or supply item does not deliver to me.
I don’t like this process at all since I can be impatient and easily frustrated by incompetence. I make an effort to be pleasant and polite and this is important. But I won’t put up with unnecessary delay or non-delivery.
OMG, you are so correct. I have even hand-carried a hard copy to my pharmacist. They are sick of me I am sure. As for my doctor, he must be tired of my messages I send to him. I know he has other things to do. He seems to writing them correctly. I have even had him be sure he is entering the correct codes during my office visit. (looking over his shoulder) He understands and is confused as well. I feel that someone entered the incorrect code or pushed the wrong key. I just need to undo it all. Don’t know how. I know all what you said. I think you said it better but it is a crazy system that lends itself to mistakes. I wish, ha, I could talk to the person/department at Medicare that handles approvals so my “case” could be reviewed and I could get a hard copy of what is on the screen they are seeing. By the way, I had a small problem with the IRS and it was handled better than this. And my issue with them was approved. One little box was not checked. Needle in a hay stack thing.
At least someone, you, get it and I don’t feel alone. Someone out there is listening/reading.
to add to what I wrote above: i’M SURE this conversation is probably ended, but I’ll add my two cents after writing an email to aetna medicare and then talking with the aetna fraud department today. If you are on a pump, and on medicare, your insulin is part of your Durable Medical Equipment. DME is covered under the medical portion of Medicare, part B, NOT THE RX COVERAGE, part D. I think that CVS bills it under “D” just so they can get more money from all of us. I have a friend who is a type 1 who has been paying $100 a bottle. I wrote out everything for her to give to the CVS pharmacy that she goes to, and also gave her a note to say that the Manager and Tech at my CVS were open and willing to telling them the procedure for getting the insulin under DME. They had the phone number and the names, but refused to call my CVS. Again, ridiculous. My friend ended up calling my CVS directly. The last time I talked with her she still didn’t have the DME coverage. You are lucky when you have staff who appreciate you, like at my pharmacy. Otherwise, it seems to me that CVS as a corporate entity doesn’t really give a rat’s posterior about fixing this issue.
Even after getting it billed correctly, one of the pharmacist, (incidentally the mother of the tech who investigated) still got it wrong on my next visit, tried to bill D and make me get a new RX from my doctor, who had written correctly the first time!! Amazing.
Pumpers can get insulin under Part D because that’s in the Medicare rules. It has nothing to do with CVS policy or possible greed (that you alluded to).
I am a type 1 using a t-slim pump and over the past 3 years have also been experiencing issues with Walgreen’s local Pharmacy. I was told just recently (last 1 1/2 weeks of struggle) that my prescription was being held up for insurance reason waiting for Dr. to notify Medicare.
This is not the first time that I have been told this. If Walgreens submits properly and or calls Medicare you will have success. I have to request the same technician every time to insure that I have success where Medicare part B is filed and not part D. This is a very frustrating on-going issue with Walgreens.
I spoke to Medicare yesterday and they claim that Walgreens never even filed the billing claim as Medicare claims that they would at least see the failed billing.
Medicare advised that Walgreens processed as Part B in Feb of 2021 and there is no reason why they should be rejecting my claim other than the way Walgreens is attempting to process the claim.
Wishing everyone good luck as you work with Walgreens. Unfortunately, you need to be forceful and persistent with them as long as you are in fact on a pump They sometimes will request you last office visit when the Walgreens tech calls Medicare so be prepared to provide the date.
Yes, I am still a frustrated Walgreens pharmacy user, even though I did get my insulin with a ZERO pay today as my supplement picked up balance.
Also insure that you allow 2-3 weeks on occasion for this to be worked out so don’t let your supply of insulin deplete to less than a vial.
I also get my insulin from Walgreens but only one specific Walgreens where the pharmacist knows me and understands Medicare rules. Usually I have no problem getting my 3 month supply of novolog and they will call my Endo for a new Rx when I run out of refills.
I used to get irritated when their automated system emailed me that my 3 month refill would be ready the next day only to find out that they failed to clear it with “Medicare” first and follow with another email the next day saying the refill was not ready. Now I take this in stride and wait a few more days when, sure-enough, they say it is ready for pickup.
Frustrating, but at least dependable.
I see the issues everyone is having with CVS and Walgreen’s. I have been getting my insulin from Kroger’s pharmacy (in fact, 3 different ones). I have had no issues once I told them to bill under Part B DME. All the pharmacist are helpful and knowledgeable. A few years ago when I moved I went to my neighborhood Publix pharmacy and they would not process insulin under Part B, so I didn’t use them. The only issue I have had with Kroger during several Januarys they collected the annual deductible and I did not get it back until late summer. This past January, I had no problem with them covering the annual deductible.
The bottom line is you need to go to a pharmacy that understands or at least will research the rule.
