So I had a separate post about this and a Few folks helped me out but the resolving of this issue was so complicated I started a new post. I have been on Medicare for four years. I had no trouble getting Humalog from Walgreens through Part B but when I switched to Lyumjev they kept putting it through my Part D drug plan and it was covered with no copay because insulin was free on that plan. I couldn’t get the pharmacy to bill Part B but eventually I got them to do it last Sept and I was told it was not a covered insulin on part B. This year i switched Part D plans and Optum Rx was my home delivery. They refused to cover it even though it was on formulary because it was going in a pump and needed to got through Part B. Walgreens pharmacist telling me it’s being denied from Part B. After another member posted a copy of LCD and and HCPCS code added July 2023 for Lyumjev use in a pump. I called Medicare and they said there is no part B formulary if it goes in a pump it’s covered. Called Walgreens back and pharmacist gave me number for Walgreens Medicare department. Called them yesterday and person I spoke with said it’s covered but Walgreen is not set up to bill Part B for Lyumjev, just Lyumjev mind you. They can bill part b but not for Lyumjev. Told me to go to another pharmacy. I had it sent to CVS and met with the pharmacist and asked her to bill Part B. But they didn’t have the script yet so when it came through I get a notice my part D plan covered it! I called pharmacist and asked them to put it though Part B and they did it while I was on the phone and it went through immediately. Then I figured it out. The UHC drug plan covers it but Optum Rx which is the mail order delivery with the plan would not. But it is covered on Part B. If you’re using Walgreens and are having a problem go to another pharmacy!
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