[Diabetes-Talk] Medicare Policies That Impact You.

[Eileen Scrivani]

Veronica,

Insulin used with a pump must get billed through your Medicare part B, it is “not” covered by your prescription plan D/rx coverage. You need to use a Medicare approved supplier. For instance I have been using RiteAid for my insulin and they are approved by Medicare. When I need to refill insulin my local pharmacy has to have my doctor do special paper work about 2 times a year and paper work is faxed back and forth between them, the doctor & I suppose Medicare part B. Just this past year the pharmacy changed to a Walgreens and I was afraid they would not be covered, but they are covered. However I will add that my local store is a bit nuts since they are still part RiteAid & part Walgreens. Its very confusing but I appear to get my insulin covered.

When they made the change back in January/February I called Medicare and they gave me the stupidest companies to call to find out if they would have insulin. They had nothing to do with selling insulin, but were places that sold supplies if you were bed-ridden in-home. I suggest starting with local big-name pharmacies to find out if they are Medicare approved and then try calling Medicare.

Eileen


From: Veronica Elsea via Diabetes-Talk 
Sent: Friday, July 13, 2018 4:45 PM
To: 'Diabetes Talk for the Blind' 
Cc: Veronica Elsea 
Subject: Re: [Diabetes-Talk] Medicare Policies That Impact You.

Wow! Thanks for posting this, Eileen. I am just now having conversations with my endo about how to handle things once I start Medicare in a few months. Right now I just get my pump supplies directly from the pump company and have no idea how things will work once I change to Medicare. Time to just hold my breath, I guess. But many thousands of thanks for this warning.
Veronica


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-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of Eileen Scrivani via Diabetes-Talk
Sent: Friday, July 13, 2018 11:28 AM
To: NFB Diabetes Talk
Cc: Eileen Scrivani
Subject: [Diabetes-Talk] Medicare Policies That Impact You.

I got the below blurb from the supply company I use for my pump. I’m posting for the pump users on the list who may not know this.

Eileen ...

Take Action Now!
Insulin Coverage Changing to Part B
Even though Medicare has temporarily suspended their decision concerning insulin coverage changes. DMS suggests that you take proper action immediately.
When Medicare decides to move forward, they will no longer pay for your insulin pump or insulin pump supplies unless your pharmacy is billing your Medicare Part B benefit for your insulin. 
What you need to know to be prepared: 
If there is no Part B insulin claim on file for you, Medicare will not pay the claim. Patients on an insulin pump must obtain their insulin through Medicare Part B benefits. Patients cannot use VA, military or other assistance programs. 

To avoid reimbursement issues for your insulin pump and insulin pump supplies, instruct your pharmacy to begin billing insulin through the Part B benefit.

To ensure the claim is filed correctly by the pharmacy:
list of 3 items
• Inform your pharmacy your insulin is for an insulin pump • Let them know that they must use the Part B benefit (this is your red, white and blue card, not the pharmacy card with an RX/BIN numbers) • Inform them that if it is not billed correctly, then Medicare will not cover your insulin pump and supplies list end

Your pharmacy will need the make, manufacturer, and serial # of your pump for their paperwork so they may complete a DIF.
If you can not find a pharmacy to bill Part B benefits or if you have any questions, please call 1-800-MEDICARE (1-800-633-4227).
You may also want to get your doctor involved. 


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