Medicare and insulin dependent diabetes

Indeed! Insurance companies need to make a profit. Maybe in a couple of years when I start on Medicare, someone will change the existing situation for the better. Or, perhaps I should run for office. THAT would really be something!

Pump supplies and insulin are covered under Medicare Part B. They are considered Durable Medical Equipment. A lot of pharmacies do not work with Part B but in our state (Idaho) Walgreen’s does. At first it took a few months, phone calls to Medicare by the pharmacy, and lots of me refusing to pay the co-pay to get them used to filing under Part B. I also have a supplemental plan, not
Advantage, but that has nothing to do with Medicare part B covering the supplies and insulin.

Smart move. Once you make the copay, they’ve no need to learn how to file under Part B.

What you say is true for pumpers only at this time, for those of us that are MDI Part B is not an option to cover insulin. We can only get insulin coverage under PartD. We get some of our hardware, like our CGM and CGM supplies as DME under part B, but not our insulin.

I think this is a problem with the prescribing doctor. The script has to be written in some arcane and precise way.

Would a pen like this, with replaceable cartridge (durable pen) be covered under Part B?

Different brands and models of insulin pen are available. Most fall into two distinct categories: disposable and reusable.

  • A disposable pen: This contains a prefilled insulin cartridge. Once used, the entire pen unit is thrown away.
  • A reusable pen: This contains a replaceable insulin cartridge. Once empty, a person discards the cartridge and installs a new one.

Nope, at least not at this time. I have been using a digital cartridge pen for over 10 years now MDI and some doctors have called it, in essence, a pump because it doses in 0.1 units but it will most likely take at least another 20+ years before Medicare catches up with what has been available for a very long time in the marketplace. This is what I use and it does not qualify under Part B which is why I import my insulin from Canada at a huge discount compared to US prices.

Pendiq Digital Cartridge Pen

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Pump and insulin is covered under Part B because the pump is “durable” and then the insulin is used in the pump. Omnipod though never managed to get covered as a durable pump because the pod with the insulin is a throw away. The insulin I use in my Omnipod is from a pen and it is not covered under Part B anyways. They literally have/had no code for “pens” under Medicare Part B.

The question could become is insulin from a vial covered under Part B or Part D for an Omnipod? I haven’t had to really find out yet what is true because I use a pen to fill mine and that is not covered. But I have literally been told yes and nos from Medicare and Optum RX. I expect if I ever use a vial to fill my pods I’ll find out then. I am not concerned as I only pay $40 for my preferred insulin every 3 months for however much I need.

What does MDI stand for. Not familiar with that.

Multiple Daily Injections