Prialt - Pharmacies Won't Accept Medicare-Approved Amount

Northeast Agent

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Pennsylvania
I have a Med Supp client who needs to be treated with Prialt (the only non-narcotic intrathecal therapy approved for severe chronic pain). It's administered by a specially designed pump (a procedure called intrathecal infusion).

It falls under Part B (administered off-site by her doctor) and was authorized by both Medicare and her Supp carrier but the problem they are encountering is finding a pharmacy that will accept the Medicare-approved payment.

Has anyone run into this or have any suggestions?

Thanks.
 
If you can find a pharmacy that files B claims for insulin they should do the same for Prialt. Agents have suggested Walgreen's and Walmart for insulin but that seems to be hit or miss, not a corporate all in for filing B claims.

Also check with approved DME providers that offer the pump. They might know someone.
 
If you can find a pharmacy that files B claims for insulin they should do the same for Prialt. Agents have suggested Walgreen's and Walmart for insulin but that seems to be hit or miss, not a corporate all in for filing B claims.

Also check with approved DME providers that offer the pump. They might know someone.

Also have her call the doc. The drug rep will either know or can find out where to get it
 
Thank you both. I'll try those pharmacies and some DME providers.

As far as the company rep goes, my client already told me that she had no idea what to do.
 
A link to this site popped up in another thread while I was looking for something. I can't figure out how to search it for a specific item so I don't know if it can help you or not.

My apologies if it is a timewaster.

https://ccsmed.com/
 
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