In a related post to another thread, but a different category of Part B:
Nebulizer solutions (ipratropium and albuterol sulfate cubes). Am I correct that this is a Part B claim? She takes ipratropium and albuterol sulfate separate cubes of each 3 times a day in her nebulizer. Not Combivent according to her-it is in nebulizer not inhaler. First I have heard of the ipratropium. She never mentioned it to me during sales meeting, I asked her to bring all medications out and put them on the table, she did. Or so I thought. I was aware of the albuterol and her dose was listed on Part D so I figured she was covered either way.
Pharmacist at large national grocery chain said "I ran it on Part D and Part B, neither will cover it". Woman has a prescription for nebulizer and solution and bad COPD. The dosage of albuterol sulfate is listed her Part D list, so isis ipratropium (not sure about the dose), but I don't know under what circumstance Part D would cover a nebulizer solution and when Part B would cover it.
She was told it would be $200. She is extra help/LIS on F sup (daughter paying), no way she can afford full price and even then if on formulary she should not have a deductible that large if that is what we are running into. Listed price is cheap, Combivent is not cheap, but is on formulary and at most she would pay maybe $60 deductible if it is a part D issue. But she says she isn't on combivent anyway.
In a competitive bid area for DME. Does that matter, because I am guessing that the grocery store is not on the list of approved for DME? Should she call her Oxygen supplier to see if they would fill the nebulizer solutions? Do they do that? She just T-65 in October and owned her nebulizer pre-medicare. Does this make a difference? Does she need a new post-Medicare Nebulizer for Part B to cover the inhalation drugs? First time she has attempted to fill this rx, had enough from President Obamacare plan to last her until now.
I am very confused, any guidance would be appreciated. I haven't run into this yet with Medicare, only been selling a short time.
Nebulizer solutions (ipratropium and albuterol sulfate cubes). Am I correct that this is a Part B claim? She takes ipratropium and albuterol sulfate separate cubes of each 3 times a day in her nebulizer. Not Combivent according to her-it is in nebulizer not inhaler. First I have heard of the ipratropium. She never mentioned it to me during sales meeting, I asked her to bring all medications out and put them on the table, she did. Or so I thought. I was aware of the albuterol and her dose was listed on Part D so I figured she was covered either way.
Pharmacist at large national grocery chain said "I ran it on Part D and Part B, neither will cover it". Woman has a prescription for nebulizer and solution and bad COPD. The dosage of albuterol sulfate is listed her Part D list, so isis ipratropium (not sure about the dose), but I don't know under what circumstance Part D would cover a nebulizer solution and when Part B would cover it.
She was told it would be $200. She is extra help/LIS on F sup (daughter paying), no way she can afford full price and even then if on formulary she should not have a deductible that large if that is what we are running into. Listed price is cheap, Combivent is not cheap, but is on formulary and at most she would pay maybe $60 deductible if it is a part D issue. But she says she isn't on combivent anyway.
In a competitive bid area for DME. Does that matter, because I am guessing that the grocery store is not on the list of approved for DME? Should she call her Oxygen supplier to see if they would fill the nebulizer solutions? Do they do that? She just T-65 in October and owned her nebulizer pre-medicare. Does this make a difference? Does she need a new post-Medicare Nebulizer for Part B to cover the inhalation drugs? First time she has attempted to fill this rx, had enough from President Obamacare plan to last her until now.
I am very confused, any guidance would be appreciated. I haven't run into this yet with Medicare, only been selling a short time.
Last edited:
