When I first joined Medicare, I signed up for the Advantage Plan, not understanding what it really was. A salesman who came to our house only offered Advantage and didn’t mention the other options. I should have researched beforehand, but anyway, a few years later I decided original Medicare plus a Supplement and drug plan would be better for me so I got through the underwriting questions and changed to the original plan plus supplement and RX. During my Advantage years, all insulin was sent to me every ninety days from OptumRX. Then when I got on original Medicare, I was told that my insulin would be covered under Part B as durable medical equipment since it was being used in my pump and OptumRX doesn’t fill orders for Part B. So I’ve been getting my 90 day supply, several vials, from my local Walgreens. About a year ago I asked my pharmacist what he was billing it under and he replied, “Part D”. I mentioned it should be under Part B and he changed the billing accordingly. Almost every time I get my refill, Walgreens is out of stock on Humalog and takes several days for it to come in. This time I contacted them a few days before the refill date and they said all they had was one vial and I could get that and the rest later since they had to place their order. I took them up on their offer, paying the $35 for the vial. Now today I received a text from Walgreens saying the rest of my partial prescription was ready. When I was at the pharmacy, I was informed that I was receiving only one vial and that Medicare had stipulated only one vial every 20 days. There was no charge for the vial today. This makes no sense to me at all.
I was so stunned about the one vial that I didn’t notice there was no charge. So now I have to come back three times, 20 days apart for the rest of my order. It will require my prompting them every time since they are always out of stock. When I arrived home I called Medicare and was transferred about six times back and forth between my Supplemental policy and my RX policy plans. Each claimed the other would be able to help me. Finally, I talked with someone who seemed knowledgeable who informed me that what I related to him was Medicare rules and the only possible way around it is to ask my doctor to contact Medicare asking them what the requirements are for his patient to get an entire 90 day supply at one time. I doubt if this will work. Has anyone else encountered a similar experience and where do you all get your insulin from? It sure would be nice if a mail order outfit would fill this for me and send to me every 90 days. Going to a local pharmacy every 20 days is a hassle.
I work with a company called Primerica. I don’t personally deal with health insurance but in the past, we owned a Company called EasyMedicare that works in that industry. Sadly, They are becoming an independent company at the end of this month. I have enjoyed working with them for several years. You just need to have your plan available so that they can give you the best comparisons possible when you call them. I will give you two numbers to reach out to them with so that people in the future will have a potential source. If you’re doing it before the end of the month, I will give you a referral line. If you do it after the first of September, you will just call them directly. If you use the referral line you will need the following information.
Referring rep: Jesse Pogue
Rep ID: 693xn
Referral line: 1-800-579-2152
Or calling them directly: 1-800-991-4407
Whether you have just started senior healthcare, or you are several months out from starting it, They are very Informational and educational. Hope they can help you out. Maybe a change of provider for your part D will help.
Something doesn’t sound right here. This is what Medicare says about the cost of insulin under part B “If you get a 3-month supply of insulin, your costs can’t be more than $35 for each month’s supply of each covered insulin. This means you’ll generally pay no more than $105 for a 3-month supply of covered insulin.” From this link Insulin Coverage
Also check with your supplement plan. Many of them will cover the $35/vial cost. I know mine does so I pay nothing for a 90 day supply. But Walgreens will need to know to charge your supplement.
The untrained staff at your Walgreens are giving you bad information. Call the Walgreens medicare help line at 888-281-0590. They only need to know you have Medicare part B and an insulin pump and the pharmacy isn’t providing the insulin your doctor prescribed. Ask them to check the prescription to see if it meets the requirements for a 90 day fill. Also as when is the soonest you can go back to the pharmacy to request a 90 day fill.
If the pharmacy tries to give you anything less than a 90 day fill call the Walgreens medicare help line while at the store and put it on speaker.
If your local Walgreens has exceeded your good will here are some other options:
- Walgreens has a mail order service. I don’t know if they can handle Part B.
- CVS can do Part B 30 and 90 day insulin prescriptions
- Some DME companies also supply insulin but typically they’ll only have one option. Off the top of my head Advanced Diabetes Supply has humalog.
I’m getting three vials a month from my prescription D plan, at the grocery store pharmacy.Walgreens messed everything up so badly on my pods and sensors that I left almost as soon as I started.
Thank you for the information. Yesterday I spoke with the pharmacist in person and he was able to straighten out my insurance to get me my entire supply. I think the problem was the technician filling in for him that day make a mistake putting the order into the computer.
I paid $35 for the first vial, the only one they had in stock. When I came back for the remainder, Medicare charged me nothing. It’s all a mystery to me. I will call my RX plan to double check if they pay for my insulin. Walgreen’s said they did not but it’s better to check myself.
I’ve found that the pharmacist at Walgreen’s is really sharp but the ones that help over there are clueless when it comes to Medicare. I kind of hate that I have my supplies coming from all different places, but at least I have what I need, for now. My insulin comes from Walgreen’s, Pump supplies from Byrum, Dexcom sensors from Acentis, and pills from OptumRX.
My understanding is if you get insulin for pump, it can be processed as DME (on script). Or you can have it considered insulin for syringe/pen.
However there is lots of confusion between most pharmacies. There are other posts here that talk about this.
Wow, you have all the suppliers covered! 
I get my insulin, my Dexcom G6 supplies, and my OmniPods through Walgreens with no trouble, but I make sure that I always go to a Walgreens SPECIALTY Pharmacy for all my prescriptions. Thankfully, I live in a big enough town that the Specialty Pharmacy is right in town. The “regular” Walgreens never seemed to get anything right, but since the Walgreens Specialty Pharmacies ONLY sell pharmaceuticals and medical supplies, they do a much better job at working with prescriptions and insurance and making sure they have the supplies and drugs I require when I need them. Check into where the nearest Walgreens Specialty Pharmacy is near you. It may be worth the drive!
Regretfully many pharmacies have zero clue about DME. I am on a Medicare approved pumped and tried getting my insulin as DME via CVS, they could never get it right and I refused to pay as my supplemental ins. pays what Medicare doesn’t under Part D. Walgreens gets it right most of the time, though they have erroneously billed it to Part D a few times. If you have an approved pump the insulin is considered DME and is covered under Part B. Part B covers 80% and if you have a supplement, that will cover all or a good % of the remainder (depends upon the supplemental insurance). To maintain Medicare coverage for the DME, you have to be seen quarterly by your diabetes doctor (PCP, or endo).
I never knew such a thing existed. Thank you, SherryAnn. I will check for sure.
My pump is also approved and provided by Medicare. It took me awhile to discover that my insulin is covered under Part B as DME since it is used in the pump. Even Medicare folks at the customer service number don’t know this. I have explained this to my Walgreens and I think they finally understand since my last insulin cost me zero out of pocket. Medicare is complicated and Type 1 diabetes and Medicare are a tough combination.
It is occasionally useful to reference Medicare and You 2024, Section 2, Page 39:
“Diabetes equipment, supplies, & therapeutic shoes
Medicare covers meters and continuous glucose monitors that measure blood glucose (blood sugar) and related supplies, including test strips, lancets, lancet holders, sensors, and control solutions. Medicare also covers tubing, insertion sets, and insulin for patients using insulin pumps, and sensors, transmitters, and receivers for patients using continuous glucose monitors. In addition, Medicare covers one pair of extra-depth or custom shoes and inserts per year for people with specific diabetes-related foot problems.
You pay 20% of the Medicare-approved amount if your supplier accepts assignment. The Part B deductible applies. “
Hard to argue with an official Medicare publication. Medicare customer service varies (as with almost all such service) - my go to tactic with an unknowledgeable agent is to thank them for their help and then call again. You will almost always get someone else and with luck, a more knowledgeable someone.