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[IP] RE: (IP) Medicare insulin and Part B



As I understand it, pharmacies are under state jurisdiction, not Medicare's,
so I don't know that Medicare can actually do anything about it your local
pharmacy refusing to bill it under Part B. However I do know that the big
chains (Walgreens, Rite Aid, CVS, etc.) accept "assignment" which means that
they agree to accept what Medicare pays and they are set up to bill under
Part B, as you've found with Walgreens. If anyone has a problem with a local
store from one of those chains, the chains can contact their headquarters
Medicare Part B billing specialist for help. So unfortunately you may be
stuck buying from a chain even if it means driving long ways or using mail
order.

That being said, the problem with the other pharmacies refusing to provide
it should still be reported to CMS. I realize that the basic reps you call
at 1-800-Medicare might not know or care, so the thing to do is to report it
to your local region of CMS. The way to do that, at least here in
California, is to work through your local SHIP program. We have access to
our local CMS management people who are very instrumental in handling
complaints and problems beneficiaries have if we don't get anywhere with the
regular Medicare call center, as well as documenting issues that can
potentially get passed up the chain and eventually dealt with (like
reimbursement rates for Part B insulin). Nothing will ever change if they
don't know about it. You can find your local SHIP contact info at this link:
shiptacenter.org.  I do know that SHIPs in lots of other states aren't as
well staffed or as proactive as here in CA, so they may or may not be that
helpful. However, it's worth trying and definitely request to talk to
someone on staff if one of the volunteers isn't helpful. Part of the mission
of SHIPs is to advocate for beneficiaries to help them get the Medicare
coverage they're entitled to and to report on problems and forward
complaints, so they should be willing to help you, although ultimately there
may not be anything Medicare can do about it in the short term.

Pam

<I'm especially interested in the research you just did regarding this
Medicare issue with insulin.

 I have traditional M'care and pay $0 for insulin (after my Part B
deductible.).
I had a terrible time finding a pharmacy willing to bill Part B. None of the
local pharmacies (all of whom are chain pharmacies) would bill Part B and
all claimed their contracts would not let them. Finally, Wegmans (pharmacy
within the grocery store) said that they'd bill Part B so I got a three
month supply through them.

 I thought my journey was over. However, when it was time for a refill, they
said they would no longer bill Part B because it was too expensive for them
since they were charged more for the insulin than they received as payment
from Medicare. I get that, why should they lose money to provide a
medication for a client? However, I still had to find a supplier. After
many, many phone calls, emails, (and angry tears), I found a Walgreens 45
minutes away. Of course that means, twice that amount of time for the
pharmacy visit and the round trip.

 Incidentally, during this entire journey, calling Medicare was a total
waste of time. They knew nothing about insulin and Part B. It was very
frustrating but I would much prefer to obtain my insulin locally.

 I would like to take this further with Medicare and wonder how you take the
next step since I'm not appealing anything and am getting my insulin under
Part B but would like to get it closer to home.

 What words of advice would you have, Pam Brown? No rush since you've
already done so much for us recently, but when you have the time, you might
be helping me and others who have the same struggle.<
.
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