I’m at my wit’s end with Walgreens and Part B coverage. For several weeks I’ve been trying to get test strips filled. They keep asking for different info from dr (who says they already sent). They say with new year, Medicare has new requirements. So I called the Walgreen’s Medicare Dept directly to try and clear things up. Asked to speak to manager since was difficult to understand agent (heavy accent). The manager was almost unintelligible (heavier accent) along with muffled sound. Where are these places located?
Our Part D insurance doesn’t cover strips so will be out of pocket. Anyone else have this problem? We will soon be out of strips.
Your doctor has to use the right code that they give to the Pharmacy or it won’t go through. Then the pharmacy has to be willing to put it through Part B. You need a helpful person at the pharmacy to find out if the right code was used or what is going wrong with the process. When you know what is wrong you have a chance at fixing it.
I remember years ago finding out insulin was covered under Part B for insulin pumps and asking my doctor to put in a request for it under Part B. It wasn’t going through, I know I talked to the pharmacy a couple of times and got various responses like it’s waiting for Medicare response etc. I finally got an assistant that I told it’s been sitting there, can she make sure it goes through. It turns out there doesn’t exist a code that could be used for pens to be used to fill pumps. Medicare doesn’t accept pens as being used to fill pumps and doesn’t cover it. It wasn’t actually ever submitted completely. But I was never told that, they just kept saying they were waiting, that it was put through etc,
Plus sometimes Medicare has some weird rules for coverage, and sometimes your insurance has only certain brands they want to cover. I have a CGM so supposedly Medicare hadn’t wanted to cover test strips too. When I called Medicare they told me they are covered if they are bundled with the CGM. But the bundles were only with the G5. My Dexcom supplier said CGM or test strips are covered, not both. Numerous people have said they couldn’t get test strips covered when they had a CGM. But someone was saying they got it covered. I called my endo and she said yes they could get them covered under Part B, they just had to be written right, Sure enough I had them submitted to Long’s under Part B and they were covered under Part B which is free because my Gap policy covers my copay.
It can be tricky and very irritating, because not only do you have Medicare rules, but then you have your insurance rules, and then you have the pharmacy that doesn’t always cooperate or??? Not all pharmacies want to mess with billing a second insurance for the Part B copay. In this case Long’s didn’t, so I had to pay the copay which was $6.60 and submit it myself to my GAP insurance for the reimbursement.
I don’t know if the rules changed Jan 1st. So I haven’t run into it. But I do know trying to get the pharmacy to make sure of what is going wrong, and just not a pat answer probably is the first step. I can see someone just saying they need the right code from the doctor, because they don’t want to bother with checking what is actually going wrong.
I can commiserate, anyway. I haven’t bothered with working on Part B paying for strips, I use so few, but I’d been using it for insulin. Some years ago, my initial try for that with the nearby CVS was totally unsuccessful, they just refused. I want to the next nearest, they had no clue, but a young pharmacist worked on it and got my first order to work. But, when I came back for a refill, the manager came and refused, while the young pharmacist stayed in the back looking embarrassed. I asked around, and an independent pharmacist (saying that no independent would ever do it) referred me to a particular Walgreen store as one that dealt with Part B. And, the pharmacist I saw didn’t know how, but wanted to help (?), and as long as she stayed there it worked fine, particularly once I learned to order and then call the Walgreens Medicare number to get each renewal approved before I went to pick it up. The next pharmacist I was able to train, now knowing the system, but the current guy balks every time, though I’ve always gotten it eventually. My supplement has changed this month, also, so I dread my next purchase.