Medicare and Part B insulin coverage


#21

It is not Medicare. My supplement BCBS pays for my Dex and its supplies. It is the fep BCBS that determines which online med supply companies I can get reimbursed for.


#22

FYI. I finally got to the bottom of why my local CVS suddenly changed in Sept to dispense only one month of my three month Rx. There is a new rule for Part B insulin that limits the amount dispensed at any one time to a max of 13,000 units. With Humulin R U500 in 20 ml vial I hit that limit with one vial (10,000 units). It expires in 40 days but I use it longer with no ill effect. I called 800-MEDICARE and two different reps failed to answer my question as to why my Rx was limited. My FL CVS is up and running post Hurricane Michael and the pharmacist there explained the actual message they were getting from Medicare. He first said it was a cost limit. Not so, it’s a # of units issue.

It floors me when I spend the time it takes to really run down these issues how much bad info I get along the way and how little those of impacted by rule changes get informed about these MEDICARE changes BEFORE they become a problem for each of our unique situations.


#23

20 ml is 2000 units I believe - not 20000


#24

R500 contains 5x more insulin than R100.


#25

At first when I was on Medicare I was getting two vials of insulin which was great having more than 1 vial on hand especially when going on vacation somewhere. Now I can only get one vial and EVERY TIME I get a refill Walgreens has to call Medicare, tell them I’m on a pump BEFORE they let Part B, which pays for the insulin go though! Don’t try to get a refill on the weekend because the pharmacy can’t get through to Medicare on the weekends!


#26

IT HAS NOTHING TO DO WITH A MAC COMPUTER. We respond to the emails that Dexcom sends us, ON OUR PHONES. No need for a computer of any type to deal with monthly orders. Something is VERY STRANGE about your problem. VERY STRANGE.
My endo does NOT have to OK orders every month. It’s either twice a year or just once; I forgot.
We spend little time dealing with the Dexcom orders. One time they didn’t send my email so I had to call them…3 times to get the ball rolling for the month. It was a matter of getting a person on the phone, in their ordering department who actually gave a crap. :slight_smile: The first person I spoke with was very unhelpful. that was just ONE order out of 12 that required some extra attention on my part.


#27

Wouldn’t that be 13 vials of U100? Wow, I personally wouldn’t need that much for even 90 days. dang!


#28

13000 units at 60 a day is 216 days


#29

Simple math. Your point is?


#30

In reading the posts, I am guessing that insulin is covered under Part D unless you are using a pump, and then it is covered under Part B?

I feel like I get the royal run around when I try to get scripts filled and re-filled. I do know that if someone uses pen insulin, they used to get a full box of 5 pens, and it was for the number of days that would cover, for example, 25 days, 36 days, etc. Now, they break up the box and give you 7 pens if that is what it takes for a 30 day supply. And they never allow for the insulin used to prime the needle.


#31

Here is the emailed form I filled out last night for my montly dexcom supplies:


#32

right on the Part B vs Part D

It’s up to your doctor to Rx the correct amounts, just like all the extra insulin I need for priming a pump. it’s not all about JUST your total daily insulin requirements. Get your doctor to fix your insulin quantity as necessary.


#33

Huh? I didn’t do any “math”. seriously, do you need to be so snide? My point was 13 bottles is a lot more than what nearly anyone would need for 3 month period, let alone a single month, IF the rule you mentioned covers both 30 and 90 day supplies.


#34

Dave44,
I fill out the same form but my email message sends me to their website. Here is my email message and when I click on the link it takes me to: https://www.dexcom.com/medicare/reorder/[then specific to me I guess]

"In order to successfully receive Medicare reimbursement for the Dexcom G5® Continuous Glucose Monitoring (CGM) System, we are required to reach out to you on a monthly basis to verify your information. Please verify your product usage and refill needs in the link below in order to fulfill your next Medicare supplies order.

Verify Your Information [Me: it is a link, not all this spelled out junk]

If you do not verify your supply needs and information, you will not receive your next Medicare supplies shipment. Should you have any immediate questions about the Dexcom G5 Continuous Glucose Monitoring (CGM) System, please call 1-888-738-3646.

Thank you,
Dexcom Team"

And because after I fill it out, per their instructions, they keep sending emails, that is why I end up calling them to get them off my back. By the way, I don’t get Contour Next from them but through Caremark CVS and prefer it that way. I actually get it thru local CVS as it is less hassle and I get 90 days worth.
It is a weird world. Maybe I will try to get through to a manager next time and see if I can do it by email like you do.


#35

can u screenshoot what comes up on your phone’s browser when u click the link within the email? does the email look like this?


#36

I don’t click on my iPhone. Prefer not to browse on it, too small print.
On laptop email, when I click on link, here is what I get:


#37

ok, that’s the correct form. what happens if you put zeroes for the counts, “not in facility”, your name, blah blah. what happens when you submit?

FYI, your doctor should put 99 refills when filling out the Rx. that will fix lots of hassles with frequent requests for paperwork. We just found out about this a few weeks ago, and because my wife’s rx didn’t have “99” on it, her order was held up onto a new rx was received by Dexcom while mine was processed in a couple of hours and my stuff was quickly on its way. live and learn.


#38

Like I said, I will investigate with my Endo this week and also Dex as this is such an aggravation. Do they think I am suddenly going to stop using my lifesaving supplies? They don’t have a clue.

Will ask my doc if he knows about ‘99’. I am amazed if that works.

Oh, I do all the stuff as you said and submit. It appears to go through. When I complain about still getting emails they say ‘the system is not worked out yet’ or something like that. But I can’t take a chance my order will come thru. I did one time recently and I got a threat I would stop getting supplies if I did not respond, which I already had via website. So… I will try for the email reply.


#39

so do you NOT get an email that is entitled,“Your Dexcom Order is Being Processed” just moments after hitting Submit?


#40

I don’t recall that I do but it has been a few weeks. Will see if anything in trash but doubt it. My memory can’t be trusted tho!

from iPhone