Need help - having trouble finding pharmacy to bill insulin for my pump under Medicare Part B not Part D

By skross Latest Reply 2018-04-20 17:11:53 -0500
Started 2013-10-03 02:19:36 -0500

Under Medicare DME insulin pumps and the insulin used in them are both considered DME. Medicare provides 80% coverage for insulin pumps plus 100% coverage for the insuin used in the pump. However I cannot find a pharmacy who will bill the insulin under Medicare Part B. Can any Type 1 Medicare Diabetics let me know who you are using? I've contacted my doctors, pump manufacturers, Medicare, online and management, Eli Lilly head pharmacists, Target, Walgreens, CVS and Target but no suppliers yet. I did contact RiteAid who will provide it if there is a RiteAid in your state. Unfortunately, they are none in Florida.

13 replies

G-Ma 56
G-Ma 56 2018-04-20 13:23:43 -0500 Report

I am having the same problem. Unfortunately, since RiteAid was bought by Walgreens, they won't fill it anymore because they don't have the correct contracts. What I can say is you're more likely to find a small, non- franchise pharmacy is going to be the only places to get it. I will let you know what I find out in my searches.

Type1Lou 2018-04-20 17:11:53 -0500 Report

I have been able to get my local Walmart Pharmacy to fill my pumped insulin under Part B for several years now…but, you have to be vigilant since they have sometimes tried to refill it under Part D…but they've corrected it when I've asked them to do so. Also the Part B RX must include the ICD diagnostic code (Part D Insulin RX's don't need this). Your RX must also state your insulin is used in a pump and must include a precise number of units to be used per day (a range of units is not acceptable nor # of vials).

KRB2016 2016-11-02 14:27:49 -0500 Report

I am having problems with this same situation today. Anyone care to comment on pharmacies that are actually taking part B Medicare for pump infused insulin? Particulary mail order. thank you

Yerachmiel 2013-10-16 13:48:02 -0500 Report

CVS learned how (from me,) send message will give you pharmacy number for your pharmacy (seriously will work if you prove out true) They lose money so they don't want to do it)

Yerachmiel 2013-10-16 07:54:22 -0500 Report

I've had to do this three or four times since i started on medicaire. The two biggest problems are that the pharmacists "never hear od this before" and so they are completely unaware of this law. The second (and usually much bigger) problemi is that the coverage level for insulin is about halfof what it is under part D (pharmacy) and so the pharmacy does NOT want to give upthe extra income (the repayment rate for Apidra, Humalog and Novolog all seem identical (if my pharmacy is billing correctly). The pharmacist told me it is a major LOSS for him to sell me insulin under Part B!! [I have since went back to using Novolog and switched pharmacies so I am now OK).

I acrtually worked with the medicaire people, the medigap company to obtain the correct paperwork, filled in all of it that I was able (i.e.anything BUT the pharmicies name, address and state/federal ID numbers). I also called the CVS main support number and worked with their state representative. If you need a copy of the paperwork or other things I will do my best to find them and either post where they can be downloaded or hopefully someone can tell me how to upload a document or three…

fatso200 2013-10-10 14:22:54 -0500 Report

If I took insulin for my type II diabetes, I'd be temtped to take an overdose and go from severe hypoglycemia. My dr doesn't want me to have insulin yet but I cannot stick with the regimen. This morning I had 6 dunkin donuts and tonight I'm having pasta. That will kill me. I just don't want to go blind. I smoke so maybe I'll get lung cancer. I don't want to live anymore and I pray for death.

skross 2013-10-06 07:07:09 -0500 Report

Thanks Jacqueline, I would use them in a second. I belonged to Costco in NJ but there are no Costcos in my area only BJs but they have no pharmcies.

old biker
old biker 2013-10-03 08:53:18 -0500 Report

Try going online to to find a contact supplier. I am not sure how part B works. Unless I am reading something wrong and that could be. There is the yearly part B deductible that applies to insulin supplies that needs to be met first.. Not really sure how part B works. I get my testing supplies and insulin with part D coverage I have

skross 2013-10-03 14:30:34 -0500 Report

old biker, thanks, but I've gone thru the supplier list. You cannot believe the number of errors on it. The deductible is covered by my supplemental. The important difference is that under Part B the insulin is not counted against your yearly drug allowance plus there is no deductible since the insulin is considered as DME. Susan