As people who are on Medicare and wear a pump, we know that insulin is only covered through Part b and d. I have tried to put it through Part D and my Medicare Plus Blue will not allow it. Now with the new law going into effect Jan 2023 for a cap of $35/month for insulin, I read that ONLY for Part D. Consequently, insulin is still way more expensive through part b than part D.
Any comments or suggestions?
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I do not have specific experience with this but i understand that insulin used in Omnipod is covered from Part D. That may be helpful.
This issue is very coverage specific. My Omnipod insulin and pods are covered under Part B and my secondary BCBS picks up my copay so zero out of pocket to me. I use the old system. Converting to DASH would cost me $500/year copay for pods via Part D. IDK if my insulin would shift to Part D if I were using DASH.
The news that insulin will be capped at $35 under Part D is a big question mark to me. We all know that not all insulin is the same. Currently Medicare is billed $1200+ per 20ml vial for my Humulin R U500. I don’t recall what CVS is actually getting. When CVS screws up the data entry my copay would be $230+. Thankfully by now I have all the right buzz words to explain to the pharmacy techs how to bill my Rx correctly. (Why I have to repeat this every few months is a story for another thread…) I seriously doubt that my insulin will fall under this $35 cap. And I’m certainly hoping that billing does not change from Part B or shift to Part D only.
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Not sure if that will fly with Medicare…I am getting Dexcom via “regular Medicare” (Part B) and when I was shopping for Part D prescription plans I did not see any that listed Dexcom in their formulary. The good news is there is no copay for the Part B Dexcom supplies because I bought a Medicare Supplement. I was limiting my search to those Part D plans that cover the Omnipod 5 so Part D plans that cover Dexcom might be out there? Not sure. Also of note I never found one that covers both Omnipod and Fiasp.
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