Medicare and Part B insulin coverage


#1

I normally get a 90 day supply (3 vials) of insulin for my Omnipod pump. My local CVS is saying that as of now Part B Medicare will only fill my Rx for one vial per month even though the script is written for 90 day supply. So anyone else hearing the same on their recent refills??? Meanwhile, am trying not to freak at only having one vial at a time on hand… Second question: The pharmacist also said they cannot transfer Part B Rx’s. Each location, even in the same corporate system, must have an original Rx. Anybody else heard or experienced this???


#2

My wife has no problem getting two vials a month under med B - her pharmacy makes the same claims about Med B transfers - must be a medicare rule


#3

I just starting receiving my insulin under Medicare Part B this year (2018) from CVS. The prescription is written for five vials every 90 days and that’s what I pick up each 90 days.

Several years ago, I was getting glucose test strip under Part B from Walgreens. My 90-day quantity was 1,400, an unusual quantity, but that’s what I was using at the time. Walgreens required that I come back once a month to pick up partial 90-day quantities.

After I did this for several months, I complained to a new pharmacist on duty. I told her that I thought this monthly delivery of a 90-day quantity was ridiculous. She thought it was silly, too, and made a phone call. Thereafter I received my full 90-day quantity every 90 days.

I think your monthly quantity of insulin is likely the result of CVS wanting to make this inconvenient for you and motivate you to take your business elsewhere. I suspect that the pharmacies do not make much money on Medicare Part B insulin and would be happy if they did not fill this order. This is simply speculation on my part.

I have a slightly off-topic question. Omnipod does not qualify under Medicare Part B for the original “pump” purchase as well as the ongoing supplies. Instead these items are covered under the pharmacy benefit instead of the durable medical equipment benefit. Do other Omnipod Medicare users get their insulin covered under Part B?


#4

My first refill under Medicare was a 90 day supply., 3 vials. CVS is now saying a 30 day supply only which for my insulin is one 20ml vial. Sounds likes this matches your wife’s experience. Thanks for your reply. :sunglasses:


#5

Thanks for your reply, Terry4. You always have solid experience to share in your clearly written posts. My first refill under Medicare was the full 90 day supply which why this 30 day supply only “rule” that my small CVS in rural FL has me wondering. My first refill was another CVS. IDK if I will hear the same 30 days only on test strips or not. First refill under Medicare was full 90 days for me, 540 strips.

That’s an interesting angle on pharmacy cost. The cash price on my insulin is $1500+/vial so I have to believe that somebody’s making $$ on it but lots of hands in the cookie jar! (…not mine of course :grin:).

Medicare will cover insulin and strips for Omnipod. I’m blessed with good 2nd insurance which still covers my pods under their DME coverage. The PDM is under Part B as a “blood glucose meter”. I was spooked that my secondary might follow Medicare’s decision to consider pods as Part D which would then give me an Rx copay on them. So far… knock on wood… no change in their policy on that. :sunglasses:


#6

I get a 90 day supply from Walgreens. Walgreens and Medicare works better for me then CVS.


#7

I use Kroger Pharmacy here in Ohio and they will only give me on month’s supply on both Insulin (Humalog) and test strips. I order them together and pick them both up at the same time.


#8

I have used Walgreen’s on Magazine Street in New Orleans and at Championsgate in Davenport Florida for my part B insulin for over 5 years using original Medicare and AARP “F” supplement. While it took a bit of hassle and help from the pharmacist at each of these locations to get started on Part B, I have not had any problems filling my 90 day supply of 6 vials of Novolog except when they did not have enough on-hand. As I travelled back and forth I could fill the Rx at either pharmacy.

A TuDiabetes post from a year or two ago noted a Walgreen’s contact to help with the PartB vs. PartD problem: 217-554-8766.


#9

Looks like I should change over to Walgreens. Thanks for the info!


#10

Good luck with Walgreens. My wife and I just dropped them after less than a year, due to one issue after another. Too many to recount here, and we moved back to Target where it’s now CVS. So far it hasn’t been bad, except I had to “school” the manager about insulin on Part B for pumpers.


#11

Guess it’s the devil you know vs the one you don’t.


#12

I am on Medicare.
I get 90 days of insulin through CVS caremark online.
But I have to get my Dex supplies through Dexcom (my new required, by 2ndary BCBS, online insulin pump supplies company, Edgepark, will not work with Medicare) and Dex will only give me 30 days worth and I have to call them every 30 days and go through the same list of questions every time. And my Endo has to ‘qualify’ me a total of 16 times per year. 12 times for Dex and 4 x that I make my Endo visits q 4 months.
Edgepark will only give me 30 days of insulin pump supplies.
This is outrageous. I have gotten 90 day mail order supplies for many years before this year.


#13

https://ccsmed.com/

has been great for years - never a problem with 90 days

Also use https://www.myehcs.com/

for Abbott CGM - never a problem - very good


#14

I also used Caremark for insulin before I started Medicare. Then I was told to use local CVS for part b insulin for my pump. Was getting my full 90 days from local CVS but in Sept they started only giving me 30 days, 1 vial, of my 90 day supply.

Now here’s the once in a lifetime, rotten chain of events. CVS would give me my second vial of insulin on Oct 20th. On Oct 10th, Hurricane Michael hit the panhandle. My home is totally destroyed. I’m now evacuated 900 miles away safe but hating Medicare rules. Part B Rx have be “original”, no transfers. I have a paper back up Rx but Maryland CVS says the Rx must be by a MD doctor, not Florida, so they won’t fill it. If I got my full Rx in Sept, those vials would be with me. Lost my CPAP supplies, same song and dance, can’t fill in MD. Was told by CVS main customer service that the FL CVS has phones now so calling them tomorrow to see if there is any solution. I have one extra vial right now. Never had my supply so low and hate it! It should not be this difficult under Medicare.


#15

obxdiva,
My problems pale in comparison to yours.
Have you tried getting a script from an Urgent Care center? If you have any proof of diabetes with you? Ditto cpap supplies? It may be that the cpap company will contact the same one, if it is national, in FL and take care of that. I am sure you have tried everything.
Also, I have found that different drug store managers are different so you may have a better chance if your phone call to FL doesn’t work to try another MD CVS Pharmacy manager.


#16

Tony24, I can only use the med suppliers that have a contract with either Medicare or BCBS and also it depends on part of country you live in. I am in NC and can’t access a good one in CA I have heard of. Rather not pay out of pocket as i am thinking of doing that with Tandem x2 because my medtronic 630 has 3 years to go and I hate their enlites of whatever variety. Want dex and x2. The decisions one has to make as a T1d are just mindboggling. Thanks for the ref though.


#17

I use CVSCaremark under my Medicare Advantage plan and have been getting 9 vials every 90 days.


#18

My wife is on medicare and gets supplies from ccs and edwards


#19

that seems very odd to me. We are on Medicare, get our Dex supplies from Dex and it is all handled by emails every month. No phone calls needed (unless something goes wrong).


#20

Dave44, I do the website Q&A per their instructions, and still get emails to call. I don’t know if they can’t deal with a Mac computer but that should not have anything to do with it.
Sometimes they tell me to ignore the email and sometimes they ask me the same questions again (are you in a nursing home?! how many of each item do you have, etc).

Does your dr have to OK your Dex orders monthly? I have this message from Dex to deal with right now:
“If you happen to speak with your Health Care Provider regarding this request, please have the documents faxed to 877‑633‑9266 or emailed to [customerservice@dexcom.com].
Dexcom Team”
I see my Endo Wednesday or I would be calling them. It is, as I implied, a full time job just to get supplies now with these new 30 day rules for Medicare. So far, not insulin (knock on wood).