Reply
trisha01
Total Posts: 6,203
Topics: 302
High Fives: 637
Blog Posts: 61
Solutions: 71
Registered on: ‎10-31-2009

Re: Novolog Insulin and medicare part b


Leehr wrote:

Sis59 wrote:

Thank you Joan for putting the ACA in proper perspective.


 

You are welcome, Sis.... A tragic development if this denial to cover insulin gets totally out of hand!

 

Joan


Joan,

 

In many posts past, for the past year or two, I have written about the national pilot programs that Medicare had started. The first year of these pilot programs, my former pharmacy happened to be in that deal, and at the time, was the only one in my part of the state, testing it out. It was/is an independent pharmacy, not a national chain pharmacy.

 

Those of us that are diabetic that used this pharmacy, were forced to change to the meter and strips, that the pharmacy (and Medicare) wanted us to use. Even those of us that were not on Medicare at that time, had to change. (Mine goes into effect on 11/1 of this year, I even have my card already). I changed pharmacies after that deal.

 

The second year of that pilot program, even more pharmacies were included to test the program.

 

I read many forums, and lately, anyone that has been on mail-order supplies, has been running into all kinds of issues; including where children are involved, and their testing strips are also being cut, even with letters of medical necessity.

 

In one of Dennis' recent posts, about strips, Medicare and such, I posted a bunch of links for others to see which of their pharmacies are in the pilot program, and with notations on seeing pharmacies in their area that are not on the pilot deal. It is on the same page as one of the links.

 

The ones that this seems to be affecting the most - at this time - are those that do mail order supplies AND / OR have their stuff delievered by their local pharmacy.

 

In my opinion, it is going to get worse before it gets better. There's no point in me calling my senator/congress rep, as they are all for pharmaceuticals and big business. I've posted a few times in the past 5 - 6 years, that my senator was on the front page of the local print newspaper, and he said it would hurt pharmaceuticals and big business too much, to have this healthcare reform. He could give a rat's arse about any of us.

 

Unfortunately, everything is not as rosy as some want all of us to believe. There are also senators and congress reps, that have stock in pharmaceuticals (was on national news at one point).

 

Even though I have good insurance, I AM worried about the future, and what it will mean in particular to we Type 1's.

 

Trisha




Trisha

IDDM (Type 1 Autoimmune) 30+ years ~ Currently using MDI & Minimed CGM ~
Check out my diabetes blog!

  All brittle means, is that one has great fluctuations, which is pretty much hallmark for Type 1's. Some more so than others. - me
  First light brings a new day, new hope, new wisdom, and a chance to start fresh again. - me

If everyone were dealt the same amount of cards, there would be no challenges in life. Challenges are part of life's lessons, to teach us to grow in all aspects, and to learn what we need to learn, to make it in this world. Life was not meant to be fair. -me



~ New Type 1 Info ~ Insulin, Test Strips, Lancets, and other meds ~ Kidney Damage Info ~


Super Advisor
leehr
Total Posts: 2,182
Registered on: ‎11-01-2009

Re: Novolog Insulin and medicare part b

[ Edited ]

trisha01 wrote:

Leehr wrote:

Sis59 wrote:

Thank you Joan for putting the ACA in proper perspective.


 

You are welcome, Sis.... A tragic development if this denial to cover insulin gets totally out of hand!

 

Joan


Joan,

 

In many posts past, for the past year or two, I have written about the national pilot programs that Medicare had started. The first year of these pilot programs, my former pharmacy happened to be in that deal, and at the time, was the only one in my part of the state, testing it out. It was/is an independent pharmacy, not a national chain pharmacy.

 

Heard nothing about this....

 

Those of us that are diabetic that used this pharmacy, were forced to change to the meter and strips, that the pharmacy (and Medicare) wanted us to use. Even those of us that were not on Medicare at that time, had to change. (Mine goes into effect on 11/1 of this year, I even have my card already). I changed pharmacies after that deal.

 

The second year of that pilot program, even more pharmacies were included to test the program.

 

I read many forums, and lately, anyone that has been on mail-order supplies, has been running into all kinds of issues; including where children are involved, and their testing strips are also being cut, even with letters of medical necessity.

 

In one of Dennis' recent posts, about strips, Medicare and such, I posted a bunch of links for others to see which of their pharmacies are in the pilot program, and with notations on seeing pharmacies in their area that are not on the pilot deal. It is on the same page as one of the links.

 

The ones that this seems to be affecting the most - at this time - are those that do mail order supplies AND / OR have their stuff delivered by their local pharmacy.

 

I receive my medication prescription by mail  through Express Scripts  I order my test  strips and insulin strips through Rite Aid locally .They work directly with Express Scripts for my  T/strips and insulin. C who also works directly with Medicare  delivers to my home  via UPS  - my pump supplies. 

 

In my opinion, it is going to get worse before it gets better. There's no point in me calling my senator/congress rep, as they are all for pharmaceuticals and big business. I've posted a few times in the past 5 - 6 years, that my senator was on the front page of the local print newspaper, and he said it would hurt pharmaceuticals and big business too much, to have this healthcare reform. He could give a rat's arse about any of us.

 

 In my district we [ Diabetics of all ages] meet with U.S. Rep Peter DeFazio once a year  and he listens to us for two hours  or so; his staff is there writing down issues and suggestions. We do get results most of he time.

 

Unfortunately, everything is not as rosy as some want all of us to believe. There are also senators and congress reps, that have stock in pharmaceuticals (was on national news at one point). 

 

Seen through Rosy glasses?  There are working parts of our health care now!  2014 will bring more relief but for now, it is tough going!   I have learned long ago to not believe  all that  I hear on radio, TV or read in the papers.  There is a lack of  truthfulness and ethics that have drop to lower levels and have gone viral in our congress and the news media  some time ago! I check the facts through the congressional records and personal chats with elected admin folks. 

 

Even though I have good insurance, I AM worried about the future, and what it will mean in particular to we Type 1's.

 

I believe that we all are concerned. So in my mind, If we do not push our Congretional Congressman  as hard as possible  to do something about our insulin supplies - well, there will be more suffering over a longer period of time and especially more cost!   I suggest public letters can draw notice to our insulin issues quite nicely and very public.  Stir the pot!!

    Also, I understand the frustration, the lack of con  I hear and read about.  Some of us are really hurting and this is WRONG!  The entire matter is confusion to say the least!  If we do not take action, however,  the answer remains "NO"!!!  And could/may get worse!!!!   There will be  glitches  in the Affordable Care Act at first as with any new program at any level; Especially when having to eventually deal with 300 million people!  Its going to be like sweeping Ants - at first!
All of you reading this ay not know that there Are actually four  [4] different Medicare Administrative Contractor [MAC] Regions who Administer Medicare.  Some of them may interpret the CMS rules differently thus the troubles begin!. So our Congress needs to know which contractors are causing this non coverage of insulin issue.  It is only because of effective lobbying by these rapacious INSURANCE COMPANY'S that this program is administered by the contractors instead of by Civil Service employees as it should be.  Perhaps I am  wrong;  perhaps not?

 MAC groups:
    Jurisdiction A NHIC Corp (National Health Insurance Company)
    Jurisdiction B National Government Services
    Jurisdiction C CIGNA
    Jurisdiction D  Noridian
     
 I have a VOICE and will I USE IT  - as needed to win this insulin issue!

    Thanks Trisha  - for all that you do for us here. :smileyhappy:
    I guess I am just a cock-eyed optimist!

    Joan :smileyhappy:

* Type 1 Diagnosed for 56 years as of Nov 2013
* 50 Year Type 1 Medalist Award from Joslin Diabetes Clinic (Harvard Medical School)
* Medtronic Paradigm Revel 523 insulin pump as of March 2011
* Insulin: Humalog
* Food Allergies: milk, yeast, corn
* Hashimoto's thyroid disease
* A bit of arthritis
* One kidney due to benign Angiomyolipoma.
* Volunteer Community Disaster Co-Coordinator
* Hobbies/Interests: Wildlife Naturalists, artist, gardening, music
Frequent Advisor
dublgully
Total Posts: 149
Registered on: ‎09-12-2013

Re: Novolog Insulin and medicare part b

Hi.  I am a new member to this great board!  Unfortunately, this topic is what brought me to the ADA in the first place!

 

I haven't done a personal Background yet, and not really sure.  But I am Type 1. Diagnosed in 1974 at age 20, six months after having my daughter.  No indication of diabetes throughout the pregnancy, and the OB/GYN was probably the most shocked of all the docs.  So, 2014 will be my 40th Anniversary.

 

I've  used a Medtronic Paradigm 723 since 2005.  I am on Medicare and have a Supplement policy.  I also received my pump supplies from Liberty Medical.  Actually, I have been using Liberty since I got my pump.  That would be the pump supplies, including the Novolog insulin.

 

I live in eastern North Carolina.  (This is important for this discussion)

 

I also received notification from Liberty that they would no longer be providing pump supplies, probably around March or April of this year.  I also received a letter from Medicare sometime early 2013 or late 2012 telling me that Medicare was changing the way they were going to handle the diabetes supplies.  It went on to tell me that my 'area' (zipcode) was covered by a provider 'bidding' program.  I could only receive my diabetes supplies from a winning bidder.  If I chose to use a provider that was not an 'approved' bidder, then Medicare would not cover the cost of supplies, with no exceptions.

 

Unfortunately, as I am prone to do, (kick me, twice) I didn't think there would really be much difference, just a different company.  Which saddened me because I really have had good service from Liberty, but to help save 'Medicare', no problem.  Or so I thought.

 

I had my PCP write me a script for Novolog for pump use only, specifically; and also a script for insulin for injection bolus.  And I took them to my local pharmacy.  I explained to them about Liberty and that I needed to find a supplier for insulin and pump supplies.  (The local pharmacy is Rite-Aid related, but not their name)  They said no problem.  I explained that the pump insulin had to be filled under the Medicare B, not the D.  If I used part D, I would be in the donut hole within a couple months, just from the insulin.  They said no problem, but they had to call their district office because they handle all the Part B filings.  It took them 3 weeks to get through the Medicare Part B, but they told me they could do it.  Happy, I drove the half hour in to town.  Got there, and they apologized because they said their insurance expert said they couldn't sell it to me.  Why?  They said they couldn't afford to sell it.  What?  They said they would lose over $375 for each insulin prescription for the pump.  (I use about 4 1/2 vials of Novolog per month)  And they are not permitted to fill a prescription for more than one month, due to new Medicare regulations.  Well, I needed insulin, so I just got a month's supply under the Part D Prescription coverage.


When I got home, I called Medicare and figured I needed to find out what I needed to do. So, I call Medicare on their 800 line.  The nice lady that I spoke with told me that she would be happy to give me 6 approved providers that I could use, but that there were many more on their website. Oh, great, thank you, yes.  So she gave me 6.  But when she told me one of the names, I interrupted her, and said I know that that company does not do the insulin for the pump.  They were local to me and I had talked to them before.  She said whoever told me that was wrong.  They have to supply it because they were a winner on the bid program.  I said, OK, maybe they have changed.  So I proceeded to call each of those 6 providers. NONE of them provided insulin for the pump.  Five of the six only provides diabetes testing supplies.  And the one I had previously talked to, only provided hard goods for the pump, no insulin.

 

I started to detect some kind of a problem when I got on the Medicare.gov site to find an approved provider.  Oh, there are pages of providers listed.  I called about 20 of them before I realized that Medicare considers a company that provides only 'meters and testing strips' can be on the list as an approved provider.

 

One of the major 'approved' bid winner provider has a great website and you can order your supplies online and have them delivered.  Wonderful!  Finally!  Oops, when I went to the checkout screen, my total was about $2000!!!  So I finally got through on their 800 number.  Yes, they are an approved bidder, yes they do supply pump hardgoods, yes they do supply insulin for the pump.  BUT, they do not accept any insurance for the insulin, they will only supply insulin for private pay.

 

So then I just started calling all the pharmacies in the phone book, since the website didn't help.  Nothing, no one, nadda.  I have been on this search since around July, 2013.  And I am still looking.  I have had to use my Medicare Part D to get my insulin twice now.  I just got my notice that I am going to be in the donut hole probably by next month.

 

I was referred to a hospital that is about 110 miles away because one pharmacy told me they thought that they had heard the hospital would  do it.  I called them.  No, they are only allowed to fill for people in their area.  Not me.  My zipcode isn't in their area.  Besides, the lady told me that Medicare REDUCED the amount that they will reimburse for the insulin.  It is lower than it was last year.  She told me that the amount that Medicare will reimburse NOW is the amount that the hospital paid, wholesale, to get their insulin supplies, in 1989!

 

Another provider that is not 'approved because they didn't win the bid' told me that she had a sister-in-law in Medicare govt and she said that Medicare was trying to break down the large mail order companies so the local providers can get the business.  Personally, I think someone at Medicare that wrote the stupid regulations and bid program had their head stuck somewhere where the light doesn't shine.

 

I'm still looking.  Our local CVS, Walgreens, etc, can't provide it under Part B because they did not win the bid for this area.  And the companies that did win the bid for this area either don't and never have sold insulin or now will not accept Medicare.  By the way, that one that has the website, they were the only one on the entire list of approved providers that actually even carried insulin for the pump.

 

Judy

dx'd  Type 1974

Medtronic Paradigm 723

born 12/1951

trisha01
Total Posts: 6,203
Topics: 302
High Fives: 637
Blog Posts: 61
Solutions: 71
Registered on: ‎10-31-2009

Re: Novolog Insulin and medicare part b

[ Edited ]

Joan,

 

***************

Joan,

 

In many posts past, for the past year or two, I have written about the national pilot programs that Medicare had started. The first year of these pilot programs, my former pharmacy happened to be in that deal, and at the time, was the only one in my part of the state, testing it out. It was/is an independent pharmacy, not a national chain pharmacy.

 

Heard nothing about this....

**************

 

Here is the link to Dennis' post....    p.s. >> where I put all of the links.....

 

http://community.diabetes.org/t5/Adults-Living-with-Type-1/Another-Report-about-Recent-Inaccuracy-of...

 

*****************************************************

 

I am not going to argue with you, over the political aspect of this. I put in my original post to you, what my senator and congressman have said. It was front page news of the local print newspaper. Your senators and reps are totally different than what ours are.

 

*********************

Thanks Trisha  - for all that you do for us here. :smileyhappy:
    I guess I am just a cock-eyed optimist!
***********************

I also am an optimist. You should know that by now! :smileyvery-happy:  :smileywink:

 

Trisha

edited for a typo




Trisha

IDDM (Type 1 Autoimmune) 30+ years ~ Currently using MDI & Minimed CGM ~
Check out my diabetes blog!

  All brittle means, is that one has great fluctuations, which is pretty much hallmark for Type 1's. Some more so than others. - me
  First light brings a new day, new hope, new wisdom, and a chance to start fresh again. - me

If everyone were dealt the same amount of cards, there would be no challenges in life. Challenges are part of life's lessons, to teach us to grow in all aspects, and to learn what we need to learn, to make it in this world. Life was not meant to be fair. -me



~ New Type 1 Info ~ Insulin, Test Strips, Lancets, and other meds ~ Kidney Damage Info ~


Established Member
jean827
Total Posts: 1
Registered on: ‎10-31-2013

Re: Novolog Insulin and medicare part b

Hello,

I am new to this ADA message board.  I am on an insulin pump and also on medicare.  Since about July 2013 I have not been able to find any pharmacy or mail order that will supply insulin under Part B medicare.  I like so many others who have written in, have a Plan D but without medicare part B will hit the donut hole probably within 4 months (possibly less).  I have exhausted all avenues to no avail.  Even had Medicare.gov employees working on trying to secure only to have them say they can understand my frustration!

 

I talked to one Pharmacist that made sense to me.....he said that perhaps medicare part B is reimbursing for NOVOLIN (which is only about a third the price of Novolog) rather than NOVOLOG....I can understand this could be a mistake on the part of whomever is setting the reimbursement for Part B formulary.  I wonder if we could possibly contact the Medicare formulary reimbursement department and see if that is what has happened.  For years I had no problem getting Novolog (or Humulog) for the insulin pump....just since Medicare changed their policies in 2013.  I don't have a problem (so far) for getting other pump supplies, just the insulin for the pump.  Does anyone have any suggestions as to how we could make contact with the actual Medicare formulary.  This is not only a big problem it is a matter of life and death.  Maybe the only way out is when we start having to go to the hospital with problems resulting in trying to conserve on the bit of insulin we are able to get before hitting the "black hole" in Part D.

Frequent Responder
J_one_81_ps3
Total Posts: 221
Registered on: ‎10-05-2011

Re: Novolog Insulin and medicare part b

Lol ....when in doubt blame obamacare..... smh...



_________________________________________________________________________________

Type 1 dx. on 7-26-07......enjoying every bonus moment insulin allows, even the painful ones......
Occasional Responder
barbking
Total Posts: 6
Registered on: ‎08-22-2013

Re: Novolog Insulin and medicare part b

I have to get novolog for my pump through medicare part d also but my dr said that novolg will help with the cost once a person gets in the donut hole. so we shall see. Good luck.

Occasional Responder
SteveTC
Total Posts: 9
Registered on: ‎09-02-2013

Re: Novolog Insulin and medicare part b

We simply are unable to get straight information on this issue from anybody. The pharmacists all say that their store lost the bid to supply insulin to pump users, so I'll have to go to one of the pharmacies that won the bid. But apparently nobody won the bid. The pharmacies say Part B does not reimburse them enough, so they can't get us our insulin. But nobody--the pharmacists, the insurers, Medicare--will give a straight answer about how much they will reimburse under Part B. Meanwhile, Senior Citizens on insulin pumps are being denied Medicare coverage under Part B, and nobody is doing anything about it. If the ADA would do a little investigative journalism on this issue and publish it in Diabetes Forecast, then something would undoubtedly be done quickly to rectify this nasty discrimination . But that's probably too much to hope for.

Pump wearer since 1983
Super Advisor
leehr
Total Posts: 2,182
Registered on: ‎11-01-2009

Re: Novolog Insulin and medicare part b


SteveTC wrote:

We simply are unable to get straight information on this issue from anybody. The pharmacists all say that their store lost the bid to supply insulin to pump users, so I'll have to go to one of the pharmacies that won the bid. But apparently nobody won the bid. The pharmacies say Part B does not reimburse them enough, so they can't get us our insulin. But nobody--the pharmacists, the insurers, Medicare--will give a straight answer about how much they will reimburse under Part B. Meanwhile, Senior Citizens on insulin pumps are being denied Medicare coverage under Part B, and nobody is doing anything about it. If the ADA would do a little investigative journalism on this issue and publish it in Diabetes Forecast, then something would undoubtedly be done quickly to rectify this nasty discrimination . But that's probably too much to hope for.


Hi!  It is all Very confusing right now but hang in there. Some of what I suggest may work for you.  People, insurance, pharmas, medical world are confused and my guess is it will be settling down in a month or so.  We just have to keep trying.

 

Some ideas you might want to try. Keep in mind  the results depend a great deal on your insurance plan and state facilities as what may be available to  you.  I know that if one has a pump the insulin is covered under Part B which is the way I receive insulin right now.   Again, though, it depends.

* Have you contacted the manufacturer of the insulin type you want? If not try it; they have often in the past sent a vial  if no other way to get it. Just Google the insulin brand you want.

* Do you have Part D?  If not  you might be able to sign up for Part D; go to medicare.gov/part-d   for instructions. There is a Look-Up feature that allows you to find what insurance companies offers Part D in your state. 

* Medicare Advantage Program [Part C] is another way to get insulin:  some Part C Plans include a prescription feature aagain depending on your coverage. 

* Some people call or drive to Canada to get insulin supplies.  .

Have a current dated prescription  signed by your doctor with you.

 

Hope some of the above may help you.

 

Good Luck

Happy Holidays

Joan

 


* Type 1 Diagnosed for 56 years as of Nov 2013
* 50 Year Type 1 Medalist Award from Joslin Diabetes Clinic (Harvard Medical School)
* Medtronic Paradigm Revel 523 insulin pump as of March 2011
* Insulin: Humalog
* Food Allergies: milk, yeast, corn
* Hashimoto's thyroid disease
* A bit of arthritis
* One kidney due to benign Angiomyolipoma.
* Volunteer Community Disaster Co-Coordinator
* Hobbies/Interests: Wildlife Naturalists, artist, gardening, music
Occasional Responder
SteveTC
Total Posts: 9
Registered on: ‎09-02-2013

Re: Novolog Insulin and medicare part b

Joan, you say that you are getting your insulin insured via Medicare Part B. What pharmacy do you use? I have checked with nearly 100 pharmacies, including all the major mail-order pharmacies and all of the chain pharmacies with outlets in my state. Same story from everybody. They all think or at least claim to think that some other pharmacy "won the bid" and I should go there, wherever that is. Nobody knows where that is. I worked with a Medicare representative who thought she could help me--she spent six hours with me on the phone getting the runaround from every pharmacist, often pointing out that they are not telling the truth but finally admitting that she couldn't help me--I have no legal right to obtain insulin if nobody wants to sell it to me or to accept my insurance.

 

I even got help from my Senator's office--Bernie Sanders, who is one of the strongest advocates for cleaning up the abuses by Big Pharma. Yet his staffer, after spending many hours on my case, also found that nobody is honoring Part  B coverage for senior citizens who wear insulin pumps, and legally there is nothing anybody can do about it.

 

As for Part D, everybody wants to honor Part D, because that means they can charge whatever they want--the only insurance anywhere that by law cannot negotiate prices. That's a gold mine, because they can charge twice as much as they do if a patient is covered by, say, Blue Cross. That's the only option available to me now I guess--even though it means that for every prescription refill the charge is over $1700, and in the midst of the second refill, I have to start paying the full amount because of the donut hole. That's like having no insurance at all. I'll do whatever I have to in order to stay alive, including ending my life as a pauper if needed, but this sitation stinks to high heaven. Medicare is supposed to allow senior citizens to be able to meet their basic health-care needs, but it's no good if no pharmacy will honor it.

 

But again, if you have found a pharmacy that will honor Part B insurance for insulin for pump users, please share the information! If they don't do mail order, I'll drive across the country to get my prescriptions filled!

Pump wearer since 1983