Question about Medicare

Type 1 and LADA
1

It’s looming for me and next year will begin.
Question: for insulin does the dr have to be an endocrinologist or can a primary dr suffice for forms and such.
Newby…and slow learner sometimes with new information.
Thanks!
Ann

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2

any doc can Rx insulin for you. If u pump, you can elect to get insulin thru Part B, not D.

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3

Dave44- I’ve been trying to get myNovolog through Part B all summer! Please tell me HOW to do that! The pharmacists look at me like theyve never heard of that before!

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You must be persistent. It took me almost 2 weeks for Walgreens to process it for me, and even longer for my wife which should have been a slam dunk since her rx was after mine. They kept wanting to charge us a lot of money because they failed to process the order thru secondary insurance. They acted as if we hadn’t long ago given them our Part B cards. AAMOF, my wife has had them scan that card 3x now, in about a year. It’s like the scans go into a black hole.

There are some things you must provide.

  1. date of purchase of pump (it does NOT have to be a pump provided by medicare!!)
  2. who paid for the pump (ie, which insurance co, or god forbid, self-pay)
  3. height and weight of patient
  4. pump is “continuous type”
  5. pump is “subcutaneous infusion type”
  6. last endo visit date.

Those are the SPECIFIC bits of info that Walgreens claimed was holding up my claim for Medicare. Once I gave them that info over the phone myself (no need to have the doctor’s office provide that info, nor would they necessarily know items #1 and 2), the Rx went thru in literally a few seconds.

5

Thanks, Dave, for the pointers! Next time I’m due to order, I’ll do that! (In fact, the last time I tried this, the Part B people on phone/computer with the pharmacist asked for that info, and said they MUST talk to my doctor!)
And, to add to my stress, yesterday when trying to order my pump supplies thru CVS Medical, apparently my doctor’s office didn’t circle the correct item needed- they told me “for the pump” must be circled, not “supplies”. Doesn’t make sense - the office said there wasn’t that option, only “pump”, meaning (according to her) the order was to get a pump! Seems EVERY TIME I order supplies, there’s SOME sort of problem!!
Thanks again Dave!

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6

The deal with Medicare and getting insulin thru Part B is that they want to be sure you have a pump before they pay for the insulin (80% is what they pay). My Plan F from UHC pays the balance, which is way better than Part D which results in a charge for me (prior to hitting the "donut hole) of $40 per bottle for Humalog.

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If you have a pump you need to fill out cms-10125

https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-Items/CMS1184634.html

The procedure codes must be correct - an endo will know

this will get you insulin under part B

8

The patient doesn’t have to fill out anything, actually., The endo needs to dot their i’s and cross their t’s when dealing with the pharmacy, regarding Part B coverage for insulin. And, “no”, not all endos have dealt with Part B requests because many Medicare patients are unaware of this coverage. Those on forums are more informed. Our new endo is pretty seasoned and her and her staff didn’t know what to do. That’s why it took 2 weeks of going back and forth with the pharmacy and the doc’s office.

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Exactly - you are correct - I did not mean to imply the patient had to do it - that would be impossible :grimacing:

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ah. cool.

11

I have been buying my insulin from CVSCaremark since I went on the pump. It was originally covered by my private Group prescription Plan and I was charged $50 for a three month supply. Last year I was switched to a Medicare Group Advantage Plan which also charges $50 for a 3 month supply. I do not know if CareMark is using part B or part D. If they use part B, is there a copayment? I know my My test strips are under Part B and are free.