Are Medicare pump users out-of-pocket when purchasing syringes?.
I find myself in need of syringes. And it occurred to me that if you’re on a pump that syringes wouldn’t be covered.
I’m I correct in my assumption?.
TNX
Fame
Since pump supplies are covered under Part B and syringes under Part D, there should be no problem getting coverage. In my Part D plan, syringes are covered under Tier 3 so are essentially out of pocket for me since I am lucky to never meet my Tier 3 deductible. But since a box of Walgreens brand syringes is less than $20, it is not a big deal for me. One box lasts me about 2 years because I don’t use syringes very often.
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At some pharmacies, you can buy them by the pack. Usually, the ones in a metro area will sell them by the packs. Each pack costs about 3 dollars. I do not use them often but like to have them for emergencies.
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Syringes are cheap, even if you have to pay out of pocket. Just go get some. Even a pack will last you a long time.
Slight variant on this question, but does anyone know if the Part B vs Part D thing applies to injector pens? I’m not on Medicare yet, but the date looms. My standard yearly prescription includes one box each of Lantus and Fiasp injector pens “in case of pump failure.” I have indeed had to resort to them for that purpose, but I also find pens really handy for other things, like emergency backup when traveling, or even when my reservoir is running low and it’s not convenient to change it. In that case I’ll sometimes use the Fiasp pen rather than the pump for a bolus, thus extending my reservoir supply by a few hours. Common case is when the low reservoir alert goes off just as I’m heading off to work. I have it set to warn me at 12 hours remaining, but that’s strictly basal obviously and doesn’t account for meal bolusing. So rather than being late to work, or having to do the swap at my desk (awkward!!!), I’ll just grab the injector pen and use that to bolus for lunch.
My impression is that on Medicare I’m not going to be able to get pens if I’m already getting the same insulin in vial form for my pump—it’s basically one or the other. Anyone know if that’s correct?
@DrBB, Medicare Part B covers only insulin pumps and the insulin used inside those pumps. Everything else would be under Part D. Unfair, but that’s the way it is.
Part D plans are completely separate from Medicare Part B. So you can get Lantus and Fiasp pens from your Part D plan. You’ll have to do your homework to find the best Part D plan for your needs. My Cigna plan has Lantus in Tier 2 and it is very inexpensive with a copay of only $2. Fiasp is in Tier 3 and would be very expensive.
Hello Dr BB. Pumping since 1988. Have never needed pens as I fill an insulin syringe with 20 or so units from my vial & take that with me. I have not used Lantus for background coverage as the pump companies get a new pump to you in about 24 hours & I’d rather inject my Fiasp (or whatever) every 3 hours (basal plus meal / correction) than have Lantus on board when I can start the new pump. But everyones needs are different… I’ve also known folks to refill their empty pens, and use pens to fill pump cartridges. Thank goodness for the G6 that we can restart!
Best to you, Jeannie
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Inevitably my pump failure occurred on a Friday going into the weekend and they couldn’t get me a new one until the following week. No CGM for me back then, and because I had to go for several days it would have been exhausting to try to keep up with Novolog (which is what I was using at the time) and finger sticks. If it happened now, I might do it the way you suggest. I’ve actually never used the Lantus injectors since then, though there’s a bit of peace of mind in having them. The Fiasp injectors, though, come in handy for a lot of situations.
Ah - a weekend does change everything! A good thing to know is the pens really last for years! If you don’t mind Lantus at not quite 100%… Stay well & healthy.
Jeannie
A few years ago, my trusty 523 failed while away on vacation. Called Medtronic around midnight, and they overnighted replacement, which arrived at 9 am. I had levemir with me for backup, and used it for the first time ever (from vial).
I always have syringes in my bag or car when out, and have used insulin from pump cartridge or vial on 2 occasions. (Accidental infusion set pulled out, with no spare).
I think the key words are Durable Medical Equipment. Pumps (and CGM’s) are DME the pump itself and it’s supplies (accoutrements). Pens are just fancier syringes, intended to be disposed of after use. So pens are pharmacy benefit, pumps are DME benefit
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Although one could argue syringes/pens are comparable to having a spare tire in your car !!
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Of course, but syringes and pen needles are designated one use only (although how often have we reused 'em?!)
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That’s a good analogy!
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I use Tandem t:slim and I get my pump infusion sets and cartridges from Edgepark (billed through Medicare Part B). The cartridges come in boxes of 10 and each box has ten 3 ml syringes and ten needles. I have not had to purchase syringes or needles. In fact I have a surplus since I kept the syringes and needles from the boxes of cartridges I had to discard when tandem changed them 1-2 years ago and they were no longer compatible with the infusion sets.
You’re not using those to actually inject insulin into yourself, though, right?? (Emergency/correction doses not delivered by the pump) Those are giant, honking syringes and needles. There’s 10 units between markings, so no accuracy whatever.
I have a tendency to reuse the pump supply syringes, so I’ve amassed quite a few of them… but I still keep a supply of 30-unit insulin syringes on hand for just in case.
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Sorry. I misunderstood what syringes you were talking about. Jane