Looking for information as to how I might more successfully get some of my pump and CGM supplies early since I will be out of the country on vacation when it is time for my next 3 month order. I am on Medicare.
Byram says I need a letter from “my insurer,” my insurer - Medicaid - says no way, they don’t do that. Which is correct?
What do you do?
PS The folks at Walmart pharmacy had no problem getting me some bp meds, levothyroxine etc. refilled earlier. Pharmacy tech said the pharmacist “put in a code” and it went through.
This is mostly a Byram problem. Keep calling until you get a rep that knows what they are talking about. Here’s some info that’ll help you know if they are being helpful or not…
I haven’t found any mention of a travel or vacation allowance in Medicare Part B. If you have Medicare Advantage, every plan is different and it’s up to you to read the docs.
You mentioned Medicaid, every state has a different plan, yours might have a travel allowance policy but I have no idea what happens with the coordination of benefits with Part B or MA.
Plan F: Ask your doc to send a ‘script for cgms to a pharmacy. Pay the uninsured price. Consider part of the cost of the trip. You’ll only have to do it once or twice till you have enough spares.
Not sure about Medicare exactly but I’ve dealt with this on private insurance.
I knew I would run out of insulin while in Europe and so My doctor created a new prescription that replaced the current one and that I was able to fill immediately. So it sort of restarted the clock.
Of course they aren’t supposed to do that but with a new script number the pharmacy can’t tell that it’s the same drug.
A second idea is the switch insulins. Ask your doc to order humalog instead of novolog. As a new script. There are several insulins that all work pretty much the same. This would be the same for pump supplies.
When I switched pumps I immediately got my new supplies even though I had 2 months of supplies on the old one.
I know Medicare is a little tougher to manage but the rules are similar.
Once that prescription number changes the time left to refil should be reset
spdif,
Thanks!
You bring up some good points.
Did try to reason with/speak to a supervisor at Byram twice, even with a Medicare official and got hung up on twice. Seems when they can’t figure it out they just hang up.
I don’t know of any Pharmacies that handle CGM equipment. You say they do?
PB
Timothy,
Thanks. Yes - I think having a doctor write a new prescription is the way to do it. Since I couldn’t get this from my Endo dr’s staff, my GP has done it for me. I think it will work!
Though my Edno dr. could have done the same thing I suppose, they were just never that helpful in finding a solution. Moving to a new Endo Dr. What a shame. PB
Yeah, that sounds like the Byram I’ve experienced. When you called Medicare did any of the reps say Part B allows filling early for a vacation? Assuming you have Medicare Part B.
Pharmacies selling Dexcom surprised me too. Medicare Advantage programs switching CGMs to pharmacy reimbursement is driving the change.
Walmart. They handle Medicare Part B. I’ve yet to fill my first G7 order through them so I don’t know how good they are. They should handle pump supplies too; they are listed (at least in Oregon) as a source for medical devices on Part B.
Unfortunately I’ve had to present my Medicare poker hand to a sufficiently large number of different guys over the last few weeks that I can’t remember exactly who said exactly what. However I’m pretty sure that it was Walmart (not an “expert”, just one of the regular pharmacy guys) who explained it consistently:
Regular prescriptions: Ace of drugs; my Cigna Medicare Part D card (costs me $0/month; no premium required!)
Medical equipment (CGM, pump supplies, pumps except Omnipod): Jack of blood; my Medicare card itself. This is apparently my “primary” insurance. Plus:
Queen of bones; my (Cigna) Medigap card which is apparently my “secondary” insurance.
WalMart has filled almost everything I have on Medicare before, on ACA. The change is that I’m swapping to Lyumjev from Fiasp because Cigna only do Eli Lilley (apparently). This was no problem with Walmart and neither was the Omnipod. All of this goes against the Ace of drugs.
I’ll try to remember to update when I have to use the Part B stuff. Given the horror stories presented elsewhere I won’t make any optimistic statements.
Off topic but I’m curious to know if Walmart gives you CGMs at the pharmacy counter or if the send your 'script to Advanced Diabetes Supply who mails you the supplies. Walmart hadn’t been able to bill Part B for CGMs in the past and all Google found for me was a single reddit thread where a Walmart pharmacy tech asked how to do it last year and employees said they had to get consent to send patient info to ADS.
It’s not clear yet because I haven’t done either the G7 or a test strip refill. I got paranoid at the start of this year because of the Medicare nightmare so I used my ACA plan at the max to refill everything. As a result I got a 3 month supply of G7 in March and can’t (technically) refill until 5/29 (75 days later).
I will do that at the end of May then I’ll know the answer. Ping me; ask me here, or somewhere on TUD or FUD, what happened.
I do intend to provide an update, but sometimes I forget!
When we lived in the USA I had byram healthcare for a time and they were awful about filling Rx ahead of time.
In fact it was so absurd that they would only refill my regular Dexcom Rx on day 90, even though my insurance told them they would on day 80. So I was always down to the wire and if my last dexcom failed I had to go without. This was particularly bad over long holiday weekends like Thanksgiving. I once had to have my prescriptions sent to me on the other side of the country because I was traveling and they refused to work with me on the shipment.
We live in New Zealand now where I don’t have any of these problems anymore, but I think I still may have a suggestion for you.
When we were preparing for our trip we didn’t know when we would have access to new zealand’s funded public health care so I tried to bring as many months of extra prescriptions with me as I could.
What I learned is that the pharmacy and dme benefits didn’t talk to each other. So for a few cycles I filled my CGM prescriptions with BOTH Byram AND at the pharmacy and that actually worked out great. I was able to stretch out my cgms for almost 1.5 years (reusing g6 sensors).
Cgms in NZ are now fully funded (100%) for all type 1 diabetics as of October 2024 so I only had to buy them here a couple of times. a 90 day supply cost about $1200 NZD ($700-$750 USD). So I’m elated that we finally don’t have that financial burden anymore.
Good for you being in NZ. US medical system is an embarassment to everything that is efficient and moral. All about the $$$
Yes - Byram does wait till day 90 to send them out. And that’s only if I can’t get my drs office staff to send out the notes on time.
I do partly blame medicare for this in that they require appointments and drs notes be sent every 90 days. Its just too onerous a requirement.
I checked with Walmart today - they only do the CGM business with some insurance plans, Medicare not being one of them.’
All this is made worse in that you can’t buy Dexcom CGM equipment on the open market without a prescription. No way to win that I can see.
Ugh. Depressing.
PB
Hey @jpob what’s interesting is that in NZ it’s absolutely no problem for anyone who wants it to buy CGMs. You only need a Rx if you want the public health system to cover it.
There’s only one vendor, so no market competition (other than the government which provides them for free if you’re T1D).
So in practical terms, since public funding began in Oct 2024 the only cash customers are type 2s or fitness types, which is why they’re targeting that crowd with “cheaper” variants (e.g. Dexcom One) while the government picks up the tab for the more expensive G6s and G7s.
I switched getting my Dexcom supplies from Edgepark to CVS this year. It was cheaper. I have private insurance. Had noticed Dexcom supplies behind the pharmacy counter and just called up my insurer (Blue Cross) and they said I could get CGM either through pharmacy or medical equipment. Still get pump supplies from Edgepark.
Yeah; I eventually did everything through WalMart but that was the ACA. There was one insurance company (moda in my case) and it paid for both the CGM and the pump. WalMart worked out, (WalGreen did not; we were with them before but abandoned them and swapped to WalMart. Fred Meyer did not pan out either.)
I’m still in limbo with the transition to MediCare. Who knows? I certainly do not. So far everything has been hunky dory WRT prescriptions (with WalMart) but the tricky issue of the CGM remains to be resolved.
We shall all see; I intend to report back (except in the event of unexpected death) by June, midsummer, when I fill (or don’t) my first G7.
That is correct. MediCare classes blood test equipment (CGMs and test strips) as “medical devices” and they are supplied under “Part B”.
WalMart is a supplier of medical devices (under Part B) as, I am sure, other pharmacists and general retailers of repute, are. Anyone checked yet if Amazon does Part B?
I should add that even though I keep quoting their name I am not paid by WalMart, I have never been paid by WalMart and do not own shares in WalMart; I even checked with my wife on the latter and she made an offensive comment about how much they pay and how expensive they are.
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