Good luck! I’m sure everything will go smoothly…
Just in case here’s the Walgreens Medicare dept. phone number: 888-281-0590. Thanks @Laddie for posting it. The number is the same one Walgreens pharmacies call and you talk to the same call center the pharmacies do. You aren’t talking to Walgreens, it is a company they contracted to do their Medicare compliance work.
I struck gold in reddit.com/r/WalgreensRx today where Walgreens pharmacy employees help each other. Here’s most of the process. You shouldn’t need this, no patient should need to know this, but since many people have problems with individual stores I’m going to put it here where it can be found next time someone has a problem.
- Doc sends prescription to pharmacy. Prescription sig (directions) have to say for use in pump.
- If this is your first time at Wags (Walgreens) staff may look up your Part D plan and process the prescription or they may wait for you to come in.
- Go to the drop off window, say your insulin is covered under Medicare Part B, show your Medicare card and give them your supplemental insurance card. If they don’t ask for both ask them to verify the information on your profile. If they disagree about using Part B they can verify your insulin is covered by open up the Plan parameters button in 3rd party for Medicare part B. It lists every drug and under what dx it is covered.
- Pharmacy info about the supplemental insurance: “They show up as MEDBCOB and all you have to do in make sure it’s scanned into Medicare plan before running it through.”
- Ask for the prescription to be reviewed while you wait for compliance with Wags Medicare Part B rules. Better for them to contact the docs office now and for you to know the exact problem if there is one.
- At this point they should order your insulin or pull it out of the fridge because Wags policy is (as of 2023) to fill the first time before getting the SWO (standard written order) from the doc. @Orpy has already verified her supplemental plan covers 100% of the Part B copay so under no circumstances should she ever give Wags money for insulin.
- This is where it gets nuts for the people working behind the counter. At some point your prescription is going to pop up in a reject queue. There are 3 different ways for them to proceed. One: call the Wags medicare number and listen to the hold music to create a ticket to fax the doc a form Two: create a ticket by going to teamrx-pharmacy-billing and collections-request CMN (Certification of Medical Necessity aka SWO) form. Three: This seems the most reliable 3rd Party → Medicare/Medicaid → Medicare Part B → Procedures → Summary of Procedures: Printable Job Aids → Medicare Part B (PDF) → (under the section Standard Written Order Form) → Medicare Part B Reference Guide: Claims Documentation → scroll to bottom and all SWO are available to click/print and fax the form from the pharmacy to the doc.
- The doc might fax the form back. If not someone at the pharmacy repeats the previous step. Maybe the same way, maybe not.
- If the SWO is faxed back to the Wags Medicare dept. go to step 10. If its faxed back to the pharmacy they scan it into the patients profile by scanning it like a script and then going into options-image-save card image. Then they call Wags medicare dept. and have it reviewed.
- Reconciling the $0 copay is a bit of a mystery. They have to manually code it each time to bill the copay to the supplemental. Dunno if this has to happen with you standing there or it shows up in the reject list again. There might not be any documentation for this and its just trial and error and memorization.
- For refills the SWO has to have been received and processed correctly before dispensing. Every 6(?) months a new SWO is required.
TLDR: Between the Medicare office for Walgreens having high volume of claims to look through, sending forms to wrong faxes etc, and the prescribers just straight up not being thorough enough… If someone does not literally babysit the entire process, it’s going to drag out forever.
@DrBB Advanced Diabetes Supply and USMed are mail order DME suppliers that sell Lispro so in Carol’s case there are mail order insulin options if Wags doesn’t work.