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[IP] Medicare Part B and insulin, Medicare Advantage plans and pharmacies; High Cost of Insulin



 I have an update based on Pam Brown's helpful advice. First a little
background. Since early 2013 the cost of one vial of Humalog Insulin as reported
on a review of my Part D claims has increased 53% from $145 to $222! I earlier
posted an article discussing the cost of insulin. I had no idea that the price
had increased so much. I have been paying $45 for a 30 day supply, under Part D,
which for me has been three vials.

 When I got my last Part D report from my insurer, I learned that I was about to
enter the Coverage Gap also known as the 'donut hole'. Last year I got well into
December and only paid the full $202 for one bottle of insulin. This year, I am
using about the same amount of insulin but have reached the 'donut hole'
effective with my next refill.

 This morning I spoke with a pharmacy representative at my Part D insurer,
Excellus BC/BS of Rochester, NY. After I was put on a 20 minute hold, the
pharmacy rep told me that my insulin prescriptions should have been processed
under Part B with a 20% co-pay. The good news is that Part B insulin does not
count toward the Part D coverage gap. The bad news is that my 20% co-pay is now
$44 per vial compared with $45 for three vials under Part D. I will be getting a
bill after my co-pays are recalculated but I will avoid the 'donut hole' going
forward.

I learned two things:

1. The cost of insulin has skyrocketed +53% in three years.

 2. If the Rx is written for insulin to be used in a pump, then the pharmacy
should always process it as Part B. There should be no need to switch to a
national chain such as Target or Walgreens. I use Wegmans Pharmacy and they will
now process my insulin under Part B.

 I hope this helps. If you have a Medicare supplement, the co-pay could be zero.
My Medicare Advantage plan covers my Enlite sensors and transmitter, as an extra
benefit, with a 20% co-pay. If the Medicare CGM Access Act of 2015 ever becomes
law, nobody will lose their CGM coverage when they turn 65.

Jerry Smith
.
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