Medicare Insulin

For all my 10 years of original Medicare coverage - I have no Part D or a supplemental plan coverage - I have paid 0% for insulin, no copay, under the Part B coverage for pump users. My new pharmacy says I need to pay a 20% copay of Medicare’s cost for my Humalog. Who else out there pays 0% (if anybody)? Or did I benefit from a mistake at Medicare, my last pharmacy or both?

Thanks in advance for any help. Jay

@jayw62175 - Thanks for the information. I am new to Medicare and getting insulin for my pump. Who do I contact that understands Part B coverage for insulin and can supply me with insulin? Mail order too?

I am new to Medicare too. I use a pump and have part b and AARP United Health Care supplement. I still can’t figure out how to get my insulin. Did you get it figured out yet? Medicare gave me the number for an infusion company but they don’t provide insulin.

Patricia,

I just chanced to see your JDRF posting today to my question. If seems I now will have to pay more than $0 for my copay. (I never had Part D or a supplemental policy). I do not know whether my original arrangement with the same pharmacy - not Walgreen’s - for all those 10 years was made in error in my favor or Medicare’s policy has changed. If I find out I will make another posting here.

My new pharmacy (Walgreen’s) went through their current instructions from Medicare and assured me my copay will be much less than 20% of Humalog’s list price. I have not purchased insulin from Walgreen’s and will post my cost when I do.

Page 37 in the 2019 Medicare Handbook talks about a copay for my case at least.

Re your other issue I deal with 1st party providers only, in my case Medtronic, Dexcom and Walgreen’s. I find most 3rd parties to be problematic at best.

Regards, Jay

Hi Patricia. Unfortunately I have not figured out how to get insulin for my pump via Medicare Part B (which covers 100% of the cost). I know I can get insulin with my Part D but only part of the cost is covered. Seems we need to find a pharmacy service the knows how to bill Medicare Part B for the pump-insulin. Any ideas?

FYI - This Medicare link says pump-insulin under Part B is covered (80%). https://www.medicare.gov/coverage/insulin

To read the Medicare literature, and when talking with pharmacists it appears very simple - but then when it arrives at delivery my insulin always comes through as Part D with the $135 co-pay.
I too have AARP Medicare Complete / UHC and the customer service has told me this should be Part B but those claims get denied. The UHC Optum Rx preferred UHC pharmacy had told me [email] that it can NOT bill anything as Part B.
I’m still trying.

I went to Walgreens yesterday and spoke with the pharmacist. They took down all of my information for Medicare part B and UHC as the supplements. They told me the doctor has to call in the prescriptions for the insulin and the test strips. The prescription for the insulin has to say “to be used with an insulin pump“ it also has to list the date of my last visit, which has to be within the past 90 days. They also said to have the doctor request a 90 day supply as it’s easier to get it through Medicare that way instead of every 30 days. I will update this after I hear if it’s been approved or not. They said they do this all the time but Medicare is very picky about how it is submitted.

Thank you Patricia @Pat4, I certainly hope that this works for you at Walgreens.
I’ve followed that procedure a few times at Walgreens a couple of times with prescriptions stating “… up to 35 units per day infused by pump” and I haven’t met with success - YET. A couple of times the prescription went through as Part B and was later changed back by Walgreens headquarters and I was billed under Part D - I lost the appeal.

I just transitioned into Medicare from my employer’s insurance and successfully obtained insulin for my pump through Medicare Part B at no cost to me. It took a while to figure out, but this is what I learned: Standard Medicare Part B covers insulin for pumps with a co-pay that depends on annual income. For lower income people, the co-pay is zero. Otherwise, the co-pay is covered under a Medicare Part B supplement. Processing Medicare B coverage requires a doctor’s prescription with an insulin pump diagnosis code, a recent visit with the prescribing doctor (within 90 days), information about the pump (vendor, date of purchase, serial number), and the patient’s height and weight. After considerable frustration, I got help figuring this all out from a Medicare claim processing contractor, who I called at 800 806-7320. The processor spoke directly with my pharmacist and walked her through the process of filing the claim. I ended up getting a 50-day supply of insulin with a $188 copay that will be reimbursed by my Medicare Part B supplement. Under Medicare Part D, I would have had to pay $500 for the same amount of insulin (3 vials of Fiasp). Retail price with no insurance would have been $2,000.

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@mjfedor Marty, nice work. This will help many people. Thanks!

Welcome to Type One Nation.

This is great information, thank you so much. Now my next battle will be figuring out how to get my pump supplies for my 670 G.

@Pat4
Call Medtronic and ask, they are the professionals.

They know the government and insurance companies always pay their bills on time, and you’ll be a very satisfied customer if you can get your supplies for free or next to nothing, so Medtronic would very gladly rake them over the coals for you.

I agree Pat, great information and sincerely appreciated. Today I received my Part B pump-insulin and test strips. The key was calling Medicare who recommended a local pharmacy with experience processing Part B claims. :slight_smile:

Finally got my insulin and test strips from Walgreen today at no charge. What an ordeal!

We became Medicare eligible in June. My wife, who’s been on a pump for over 30 years submitted her first order for insulin under Part B thru our CVS pharmacy. We have the AARP UHC supplement and have been told since sign-up that the insulin will be cost free. After the pharmacy jumped thru numerous hoops as Marty described, it was confirmed approved. However, they initially said we had a co-pay. After we said no, that was not the case, they contacted UHC and confirmed, no co-pay, but until the claim is processed by Medicare, and they make the connection with our Supplement plan, we’re in limbo and without the insulin. Since Medicare says they can take up to 30 days to process a claim, I have no idea how long this will take. Supposedly, after the initial claim, it should go faster for refills. Amazing, since this is a life-saving medicine used by so many people. Seems they want to wear you down with the process. CVS says they should receive an automatic message thru their system once Medicare and the Supplement coordinate the claim. What a nightmare.

First Mark @mblanch120, let me offer both you and your wife a Warm Welcome to the JDRF TypeOneNation Forum! I hope that here you and your wife will find a community of people like you who are trying to live full, active lives with T1D. And I invite you to ontibute often to these discussions.

I hope that your fortunes will be better than mine in dealing with Medicare on the horrible Part B for insulin provision. Medicare continues rejecting me - went through on the first two quarterly refills but about six months later I was billed. Still trying after many years on medicare.

I suggest, as insulin is a necessity, that you / your wife, pay the co-pay now and get the insulin - but continue your battle. I have it on my notepad to call Medicare again on Monday.

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An update to my story. After no movement or info concerning eliminating the co-pay for the insulin, I called our AARP UHC Supplement plan and was transferred to a claims specialist who was extremely helpful. She recognized the problem immediately, stating that CVS needed to enter a particular code in my wife’s profile for the claim to go thru without the need of the co-pay. Voila! It worked. The claims specialist contacted the pharmacy directly and then called me back. We got the insulin as prescribed and are optimistic that on the next refill the process will work as expected with little or no delay.

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Greetings, i am brand new to this and have my first Endocrine Clinic visit coming up on 9/23.
I am insured with Humana Gold Plus which is a Medicare Replacement HMO.
Since my initial diagnosis of T1D on 8/9, at the age of 83, I was in ICU and hospital for 5 days.
I’ve purchased Humalog KwikPen and Lantus StarSolo from a Canadian pharmacy.
I’ve gotten Humana approval for a Dexcom CMS and will likely get my Rx. on Monday; I’m also going to be asking for an Rx, for T:slim pump.
My questions are what insulin goes into the cartridge; can I use a kwikPen or what do I ask the pharmacist for?
What can I do get the necessary insulin via my Humana plan at the lowest cost or no cost.?
If it is 20%, what does 5 pack cost?
Thanks in advance…

@golfer71909 Welcome Marc to the JDRF TypeOneNation Forum! I hope that you enjoy your visits here, pick up some usable information and contribute your words. Enjoy learning “diabetes”.

Only rapid-acting insulin, Humalog and Novolog, are approved and recommended for use in pumps and you need to buy the insulin in vials - pens will not do the job. Your doctor will write a prescription for 10 ml vials - and I don’t know anything about Humana insurance. A vial of Humalog costs about $325 before insurance; Lily “Insulin Lispro” which Lilly says is a generic equivalent to Humalog costs about $167.

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