Sounds like CVS is trying to charge you under part D. You may have to explain to them that the insulin is for a pump and must be charged under part B. If they tell you Medicare wouldn’t accept it, ask them to see the printout with the reason for the rejection. When I had a similar problem it turned out I needed my doctor to rewrite the Rx with some specific language that I don’t recall now, but was printed on the rejection from Medicare.
Is this MediCare or a regular pre-MediCare US health payment policy?
I believe WalMart will generally bill secondary insurance for pre-MediCare and for MediCare they do bill on Part D. I’m not aware of any possibility of secondary insurance for Part D, I guess it might exist but I’ve not heard of such policies and given that the Part D OOPMax is currently $2,000 it isn’t obvious how any company could make money out of them.
For pump users post-MediCare it is moot because the insulin goes on Part B and comes with the pump supplies. It doesn’t take long for a supplmentary policy, i.e. MediGap, to fill in the gap, so to speak; after $257 total out-of-pocket with the right “plan”.
Without more information about your situation it’s impossible to say; there are just way too many possibilities in the US including the now very real possibility of employment insurance which doesn’t even vaguely meet the ACA requirements!
People report this happening occasionally. CVS can bill Part B and the rest to your supplemental plan just like RiteAid was doing. I agree with @LJAZ, the most likely reason is they are billing your part D plan instead of Part B. There is a tiny chance CVS doesn’t work with TransAmerica so I’d double check with TransAmerica to eliminate that possibility.
The big takeaway from all the stories about pharmacies giving people trouble with Part B is not all pharmacy staff can figure out how to do it. Let us know if you need suggestions for ways to get this resolved.
More accurately not all pharmacies will do it. So far as I was able to determine very few pharmacies will bill part B for diabetic supplies. In my case this was the CGM but it most likely applies to insulin as well.
The problem I faced is that Part B supply of CGM requires extensive documentation from the provider - the pharmacy. They just won’t do that. On the other hand if the provider is a MediCare Advantage (Part C) plan the pharmacy, no longer the provider, is perfectly happy to dispense CGMs. So I was told various lies but, at the end of the day, I had to go to a Part B diabetic supplier.
The same story may apply to Part B insulin supplies. After the law was clarified the price ended up the same on Part B as on Part D; it’s $105 on both. This applies regardless of Part C; the Part C providers get $105 too.
The problem is that the up-front on Part B is $257 whereas the up-front on Part D is (in my case) $2,000. So my endo appointment after I went on MediCraze covered the $257 (and, good news, they didn’t bill me for three months, wow did I have lots of fun with that $257!) I’m still waiting to pay down the $2,000 on my Part D plan; the biggy is the Omnipod Dash pods but the Insulin goes on Part D too because the Dash pods do.
The truth is a powerful weapon but it is completely powerless without understanding. Complexity kills.
I use CVS, too. They bill Medicare, then submit to my secondary policy. I don’t pay anything when I pick up my insulin. Another poster mentioned the description your doctor must include in the insulin Rx—that it’s used in a pump. Check the prescription label on your insulin to see if that info is on there; also ask the pharmacist if that’s in the initial script. If not, ask your doctor to re-write the script. Talk to CVS—they can process your claim with both Medicare and your secondary so you don’t have to pay upfront. (I end up paying a very small amount after the insulin script has been run through both Medicare and my secondary policy. CVS sends me a bill for that net amount.)
