Has anyone posted a list (based on personal experience or their own research) of approved Medicare DME providers that those with T1D can use for obtaining both insulin pump supplies and insulin?
I found mentions in various posts, but no single reference list that members could comment on regarding their personal experience… Such a last could save a lot of time, cost, and frustration.
As an example, I compiled this alphabetic list from numerous posts, but have limited/dated experience with only two.
I think it will depend on what Medicare coverage you have. I have traditional Medicare with a gap plan so I can go to any supplier who accepts Medicare. If you have an advantage plan they are more likely more restrictive and each plan will use whatever providers they have a negotiated contract with.
Agreed, there will be variations by plans, but that doesn’t mean there’s no value in one list that covers Part B plans and other lists for the various Advantage plans.
You will be hard pressed to get DME and Rx from the same supplier. The only suggestion is your local retail Rx than can bill insulin as Part B.
The problem is one of LAW. The Pump supplies + Insulin, both billed under Medicare Part B (DME) is finding the provider with both approvals from Medicare and licensed to have drugs in their supply chain.
I know Kroger can do it because they do insulin as Part B, but they don’t want to mess with pump supplies because they are too niche.
This is true for me. I get my pump supplies from Medtronic, my insulin from a local retail CVS pharmacy, and CGM supplies from US Med. It’s not an overwhelming hassle and I find it manageable. In each instance I get a 90-day supply.
If you use an insulin pump that’s covered under Medicare Part B’s durable
medical equipment benefit, or you get your covered insulin through a Medicare Advantage Plan, your insulin costs won’t be more than $35 for a one-month supply. If you have Part B and Medicare Supplement Insurance (Medigap) that pays your Part B coinsurance, your Medigap policy should cover the $35 (or less) cost for insulin.
From the list, Advanced Diabetes Supply (https://www.northcoastmed.com) confirmed the Part B benefit during a phone call today, but can only provide Lispro (Lilly’s generic for Humalog) under Part B.
Hi Mitch, I’ve got a list of national DME mail order companies that sell dexcom CGMs in a google sheet. if you want I can share it with you and we can adapt it into something that works for both pumps and CGMs. You’d have to be willing to commit to maintenance. Or maybe an admin will create a wiki topic
What you found with ADS is true for the other DME companies I’ve looked at. They’ll have maybe one insulin. Then there’s the second problem where all US DME companies are terrible so do you really want to trust them to deliver the stuff you need to stay alive? This is why people are suggesting to you that its better to get your insulin from a pharmacy that can bill Part B like CVS and Walgreens. Now those companies are terrible too and well on their way to bankruptcy but they are less terrible than the DME companies because the people in the retail locations for the most part really are trying to dispense medicine despite their bosses. So is it worth maintaining a list?
I get my pump supplies and CGM’s from Bedard Pharmacy and Medical Supplies. I get my insulin from Walgreens. CCS Medical was my first pump supply medical house - I rate them, on a scale of 1 (awful) to 10 (superb), at 0. On line reviews of US Med and Byram are fairly scathing. No experience with the others. I have used Adapt Healthcare – horrible with customer (non)service agents who were bored and clueless.
I think Bedard is close to perfect, no complaints, easy to work with, friendly (and competent) phone customer service/ordering.
I should add that my experience with getting Medicare DME insulin from CVS is far less than perfect. My local CVS pharmacy has not been able to successfully bill Medicare for over a year now. They have dutifully filled my every 90-day requests and have not asked for any money. I maintain standard Medicare with a supplement policy.
I’ve called and talked with their corporate billing office since I realize that their getting paid is important to me. They explained that the reason for not getting paid is on them and I’m not to worry. They said that I will continue to receive a regular 90-day supply. I’m getting the insulin I need when I need it and had to hand over no money. I have no basis for complaint yet their corporate behavior baffles me!
My comment is trying to find a provider that has the pharmacy credentials to have insulin in house and then set up to billing part B is administrative on the provider.
The rules just share how you can bill the insulin in a pump.
That article is what I started with when I was trying to figure out how CGMs were covered by my employer insurance. I spent thousands getting them from a pharmacy before I understood the DME benefits.
