New to a Pump under Medicare, insulin payment question

I just started on a pump under Medicare. I pay each month for Part B coverage, plus a Blue Cross Medicare Supplement plan that covers the 20% Part B copay after an annual deductable.

For everything to date that is covered under Medicare B, the provider bills Medicare, and Medicare sends the Supplement provider a statement to tell them what their payment part is. Often Blue Cross pays the balance before I get the monthly statement from Medicare.

The pharmacy that is providing the first insulin prescription for the pump (Walmart) says that I must pay the copay out of pocket, and I will get a letter in a month to take to Walmart for a refund.

Is this normal?

1 Like

Medicare Part B pays for insulin

There is a simple answer to getting the insuling paid in full by Medicare. The MD must write a prescription that has the following info:

1- the insulin is used in a pump

2-the insulin is medically necessary

3-the specific number of units used daily(md can create a number that is greater than what you use)

4-may need MD to send in data or charts notes, not always needed

The pharmacy needs to request the info on the Rx to get it paid for by Medicare. All too often the pharmacies think it won’t be paid for by Medicare because it’s a drug, but it fall under the part B coverage.



While I have never dealt with Walmart, that is not the way that it works at CVS. I pay zero out of pocket. When they DO ask for a copay, I know that they have messed up and tried to process it as a normal prescription. I believe that others on this forum have waged that battle as well.

In my experience, only a handful of folks working at a commercial pharmacy understand how to process a Medicare Part B prescription, because it happens so infrequently.

I may be off base in terms of Walmart, but I think that they tried to push it through the Part D pipe …

Good luck,


1 Like

Not sure you understand my message. To get insulin paid for with a pump it needs to be bill by the retailer directly to Medicare part b. Medicare will not reimburse you for your out of pocket expenses if it’s not billed directly to Medicare part B when you pick it up. Some retailers don’t understand this, as was noted in the previous message, the retailer may need some guidance. When I first started Medicare CVS did not know they could bill it directly if used in a pump with the RX written just as I listed, this is required when billing to part b, and without this info in the Rx it will not be paid by Medicare.

If the insulin is not billed to part b it’s just like any other drug, you need a plan to pay for the drugs at the ins co-pay, and Medicare will not reimburse for that cost.

Hope that helps.

1 Like

Yesterday I received my first shipment of insulin for 2023. I am on Medicare and a Medicare Advantage plan offered as a retirement benefit from Verizon. I know that the plan is using Medicare Plan D for insulin even though I am on a pump.

I was double shocked when I opened the cool box.

  1. My endo prescribed enough Novolog for 300 days at my current rate.
  2. I requested a box of 5 SoloStar pens for emergency use. Was informed this would cost $116.
  3. The invoice/packing slip showed $0.00 for the NovoLog, $116 for the Lantus with a total charge of $0.00.

We will see come November when I refill.