I am new to this community and this is my first post. I have been on the pump for 6 years and I’m wondering if any of you have encountered this insulin challenge. I obtained my insulin through OptumRX and before that Prescription Solutions. Through the many years of buying I was told by their reps to call for replacement insulin when I was down to half a bottle (I use 300 units every 2 days with a 6.7 HbA1C). The insulin was overnighted. I called yesterday for replacement insulin and,to my shock and amazement, they informed me that they no longer supplied part B insulin. I was then on the phone for 3 hours with OptumRx, Medicare, my doctor’s office, and local pharmacy. Medicare told me that insulin wasn’t part of the competitive bid process; OptumRx told me that they had to give it up. I tend to believe Medicare on this one. I’m still dealing with obtaining insulin but has anyone else encountered this type of nonchalant attitude from their mail order company? Please share your stories.
I also used OptumRx, but was told in July by them that they would no longer be supplying insulin under Part B. I assumed it was because of the Medicare Competitive Bid program, but now I think they just decided to give it up because it was not profitable. I have yet to find an alternative, so I'm searching the forums for current solutions. I hope if someone finds a solid, dependable supplier for insulin under Medicare Part B for insulin pump users they'll post it far & wide.
Hi Rick, I'm glad to hear that you were notified by OptumRx about the change. They did in fact give it up because it was not profitable. I was told by Medicare of two local pharmacies that could supply it. My concern was that they would be higher than mail order companies. Medicare DME gave me the name of these two local pharmacies along with 13 mail order companies. None of the mail order companies they listed provided Part B insulin. I spoke with the pharmacist at a local Walmart who told me that they could supply it even if they weren't on Medicare's list. Here is the odd thing, when I had to call Medicare back, the particular rep I spoke to couldn't find those original two pharmacies. My main concern, however, was the co-pay and whether or not the pharmacy would charge above that maximum amount. Medicare has a phone # that they will give to the pharmacy but not the patient. It is called the Medicare Provider Line and can be reached through the standard Medicare number. I asked the Medicare rep if they would tell me the co-pay on insulin but they refused saying they couldn't reveal that information to me, only the pharmacy. So I asked them to contact the pharmacy for me and give them that phone number. They did. My pharmacy then contacted me and told me the maximum allowable co-pay per vial. I have no reason to doubt the amount but I will know for sure when my quarterly statement comes from Medicare stating the maximum amount I should pay. The two pharmacies they gave me were Target and Safeway. My script has already been sent and I can pick it up at any time. The important thing to remember is that wherever you obtain your Part B insulin, you are under no obligation to pay more than the maximum allowable co-pay. If I didn't need my insulin so quickly, I would have called other pharmacies to determine if they get their insulin cheaper than others. I imagine they could still charge me the maximum co-pay if they wanted. The whole process is difficult when you don't receive the same information from one Medicare rep to the next when you're obtaining pharmacy information. Best of Luck on your search. The whole process can be really frustrating.