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 Part B pharmacies
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SEW4no
Member

165 Posts

Posted - Dec 28 2017 :  7:50:21 PM  Show Profile  Reply with Quote
Apparently CVS (CT) no longer will participate in obtaining nebulizer medications (budesonide). When I called Medicare DME was told I had to get it through a DME competitive bid supplier. I explained I have had my own compresser/tubing/medicine cup etc. for 6 years. Was directed to Lincare & it has been a nightmare. Today I called Walgreens & they said they can fill Rx. I also just ordered from ADC for backup. Just to note, ADC $300/6 months vs. Lincare $937 for ONE month.

So my question is, has anyone in competitive bidding areas able to use a local pharmacy for their Rx not including the nebulizer compressor, etc.?

gms
Member

USA
84 Posts

Posted - Dec 29 2017 :  5:39:22 PM  Show Profile  Reply with Quote
I get mine from the Sams club pharmacy, the same place I get all my meds.
They bill my insurance, Molina medicare options plus, and my last refill was $1.72 for albuterol sulfate .083%/2.5mg/3mL. As I understand it, it's billed to part b, not part d. For some reason, if the drug is used in a nebulizer, it's not part of the normal drug program.

Edited by - gms on Dec 29 2017 5:46:36 PM
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SEW4no
Member

165 Posts

Posted - Dec 29 2017 :  6:04:01 PM  Show Profile  Reply with Quote
Yes, there are several drugs that are used in a nebulizer cup and powered by a compressor such as albuterol, ipratropium. levalbuterol, budesonide, Brovana and Perforomist and are paid for via the standard Medicare Part B (if you have it.) I was able to find & print the most current requirements & codes from CMS. No where does it say that the medications must be obtained from a competitive bidding DME provider of nebulizers that accepts assignment. But if a pt needs a nebulizer machine & accessories and wants Part B to pay for it, then it must be obtained from a DME supplier.

I also noted that if you belong to one of the known clubs (like Sam's) their medication price is half the going rate.
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sslei
Member

100 Posts

Posted - Dec 29 2017 :  6:04:48 PM  Show Profile  Reply with Quote
My Pulmonary Has Direct RX call me each month and I get Budesonide and Brovana on a regular basis but also have two others one is Albuterol that I use in the Nebulizer , They are expensive in reading what the Medicare shows they pay , but very handy not to have to go anywhere except to the telephone and mailbox , mail carrier calls us when we have a package.
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Jan-KS
Member

USA
82 Posts

Posted - Dec 30 2017 :  12:42:26 AM  Show Profile  Reply with Quote
I'm confused by the statement SEW3no made: "But if a pt needs a nebulizer machine & accessories and wants Part B to pay for it, then it must be obtained from a DME supplier." My nebulizer medication is paid for by my medicare Part B but is supplied by my grocery store pharmacy which sure doesn't look like a DME supplier - unless the fact they carry walkers and canes makes them a DME for respiratory drugs. It's always paid 100% so I'm not worried, just confused by the terminology. I remember being confused when caring for my mother who received two of her three nebulized drugs from a DME and they arrived in the mail, but she got her albuterol sulfate at the grocery store pharmacy all for free. I slipped up once or twice and ordered her Brovana from the grocery store pharmacy and they filled it with no problem. I'm sure there is quite a monetary advantage for a pharmacy to be considered a DME.

Jan C
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gms
Member

USA
84 Posts

Posted - Dec 30 2017 :  11:19:23 AM  Show Profile  Reply with Quote
quote:
Originally posted by SEW4no

I also noted that if you belong to one of the known clubs (like Sam's) their medication price is half the going rate.



For the record, you don't have to be a member to get your drugs from Sam's club or Costco. Just walk to the pharmacy and give them your RX or have your Doctor send the RX there... and for what it's worth, you can also buy Liquor without being a member.
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SEW4no
Member

165 Posts

Posted - Dec 30 2017 :  12:09:06 PM  Show Profile  Reply with Quote
Jan - Let me try again. Regular Medicare Part B (if you have it) will pay for a compressor machine, tubing, medicine CUP only if you get it through a DME supplier. If you buy your own, you can't submit cost to Medicare. There are a very few DME suppliers that also have their own pharmacy to dispense the drugs and they accept 'assignment' & they must accept what Medicare will pay for the drug.

You can get the drug from many (but not all) regular pharmacies & they will bill Medicare B what ever they want in cost. It varies what Medicare B will pay for and you are responsible for the rest unless you have a supplement plan.

I just saw that my local CVS is no longer a 'standard network pharmacy' for my AARP plan, but the one across town is still one. Also 2 of the Walgreens in my town have been eliminated too.
My problem is that I have a hard time getting to these pharmacies & when needed (sick or winter) I have 2 people that would pick up for me. I know they won't go further away. Will talk with doc about going back to Brovana or Perforomist nebulizer meds as ADC doesn't carry my Stiverdi or Daliresp. Or could try Symbicort 3x day (ADC carries it.)

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beatlemike
Member

47 Posts

Posted - Dec 30 2017 :  12:14:05 PM  Show Profile  Reply with Quote
and for what it's worth, you can also buy Liquor without being a member.
Thanks for the chuckle!
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Jan-KS
Member

USA
82 Posts

Posted - Dec 30 2017 :  11:53:26 PM  Show Profile  Reply with Quote
Since I pay nothing for any drugs used in my nebulizer then I assume the tab must be covered 100% by Medicare part B and my Part D supplemental. I did get my nebulizer from a DME but to get it free I had only one kind to choose from - a "Vios Pro" which is super loud and takes about 20 minutes for the standard size albuterol dose to get nebulized. I also paid out of pocket for a portable battery charged nebulizer that I could take with me anytime I needed a breathing treatment. It cost a lot more, compressor is less powerful so the treatment takes forever but it's good for a backup and when the power goes out (a frequent problem in my neighborhood).

Jan C
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