I switched from Aetna to Medicare on July 1st. So far everything has gone smoothly regarding my non-diabetic medications. Also, I just received a 90 day supply of infusion sets and pump cartridges from Edgepark and I did not have any problem getting this order filled. My next step is to get my Dexcom G6 supplies from Byram and I am not due yet for these. You may wonder why I have two different companies. One of my insurance companies before I retired specified one company for infusion sets and a different company for Dexcom so I just left it that way. I may find that I should get everything from Edgepark since it went so well for infusion sets.
Anyway my question is related to getting insulin. I have the DME form required for the pharmacist to file with Medicare Part B and the pharmacist at Walgreens has indicated they will do this for me. I have used either Novolog or Humalog in my pump, depending upon what my previous insurance preferred. IS THERE A PREFERRED INSULIN FOR MEDICARE COVERAGE?
Thanks for any input. Jane
@JVG, Welcome
There is no difference as far as I know.
I know Kroger has hiccups in doing insulin for pumps processing Medicare.
I know Humalog is formulary are a local hospital. Humalog makes me itch.
Make the decision on clinical outcomes.
Let us know what you find. It is how we all learn.
Thanks.
Since I currently am using Novolog, I will get the prescription written that way and if there is a problem, I guess I will find out. Jane
both insulin’s are treated the same under medicare. It is the same cost i believe which should be $0.00 after your deductible
@JVG, I did some digging and found the requirements for a prescription for insulin used in a pump and billed to Medicare Part B for DME.
- Type of insulin including concentration (Novolog 100units/mL Subcutaneous Solution)
- Dosing including max units per day (as directed in insulin pump-max xxx units/day)
- Generic name (Insulin aspart)
- Quanitity in mL ( xxx units/day X 90 days = yyy milliliters)
The pharmacist, doctor, and I keep tweaking the prescription until the Medicare clearing house processing for my neighborhood pharmacy would accept the prescription. The three of us were surprised how detailed Medicare wanted the prescription to accept it.
Keep us informed.
Medicare has a non-discriminatory policy for the type of insulin,i.e. Humalog and Novolog, based on the prescription and the patient’s need, not like the commercial plan, which is based on insurance company’s financial interest. I find that Novolog release time is shorter than Humalog for about 5 minutes.
If you would like to get refill every 90 days, ask your doctor to round up the daily usage to “n” units that can get you “m” vials of 1000 unit.
For example: a) 44 u/day * 90 days = 3,960 u, you may get 4 vials of 1000 u each. b) 42 u/day * 90 days = 3,780 u, you will get only 3 vials (3000u), which last for 71 days only, i.e 42*71=2,982. You need to refill every 71 days, which is difficult for tracking the refill date.
@JVG:
While someone my correct me, I THINK that your secondary (supplemental) insurance may play a role in this. As I recall, Part B has an annual deductible of $196 dollars even if there is not an 80/20 rule. My Medicare supplement pays that Part B deductible as long as my insulin is on their formulary at a low tier. In the past year, they changed their formulary from Novolog to Humalog and, as a result, I changed too to keep my $0 out of pocket expenses for Part B insulin.
At least I think that is how it works … although someone more Medicare-aware may correct me.
Stay safe!
John
Thank you everyone for the detailed and helpful replies to my question.
Jane
Your plan should have a formulary ,watch it as it changed every year. My Aetna Medicare tells me when 5he change insulin coverage on me. Good luck. Nancy50
I just got on AARP website since my supplemental is with them. It is United Healthcare so I assume their formulary. Currently Humalog is preferred. Is that how you see it working?
Unless you have a retiree or other special Supplement plan, your Supplement plan will pay the 20% for Part B insulin that Medicare does not pay. There is no Medicare formulary and I know people who get Novolog, Humalog, Apidra, and Fiasp through Part B. I do not know about the Medicare coverage for Lyumjev since it is the newest of the fast acting insulins and I don’t know anyone on Medicare using it for a pump. If you do not pump, you will probably have formulary restrictions with your Part D plan. Advantage plan beneficiaries follow whatever insulin rules that the plan dictates whether you are pumping or using injections.
Also be aware that NovoNordisk has released an insulin marketed as Insulin Aspart and as a Medicare beneficiary, you may possibly get that instead of insulin labeled Novolog. Do not worry if you do; they are the identical insulin but packaged differently. This allows the drug company to have one cheaper option for insulin but still keep charging the outrageous prices to other people and insurance companies. Insulin Aspart is not a generic or biosimilar. It is the exact same insulin as Novolog but in a different package.
@JVG
I joined Medicare Part B couple of months ago. I have AARP UHC supplemental plan F , both Novolog and Humalog are covered. Before retirement, my company has UHC commercial plan, which restricts insulin to Humalog. If the insulin is under Part D, then it is a different situation.