Medicare and Nebulizer medicine

[TerryDavid]

I'm not sure where to post this but I'll try here. I went in to get my Nebulizer medicine renewed. It's nothing fancy or exotic, just the plain vanilla Albuterol/Sulfate mixture. I found out that Medicare no longer covers this. I have regular Medicare plus the backup and they have been covering it for the last 2 years that I've been on it. Just my luck ADC does not carry this product. If they do I missed seeing if when I looked for it.

Am I an orphan or has anyone else had this problem?

[jarca]

Terrydavid, 
I haven't used my nebulizer in quite awhile, but the last I filled my perscription for albuterol it was still covered.
I also checked my "part D" prescription coverage.  It also covers albuterol with "prior approval" so it seems like you should have it covered some way!
Did you supplier say why it wasn't covered? 

I've looked it up online & I cannot find anything saying that medicare has changed it's policy to not pay for it. The medicare sight says it is paid for unless the provider chooses not to accept medicare, but they are supposed to give you prior warning so you can change suppliers.

I would ask your pharmacist 1st why your medicare isn't covering it; perhaps it is just the pharmacy? 
Or you may want to call medicare and talk to a worker about it, as it seems you would have been given some kind of warning if it wasn't going to be covered any more. 

www.medicare.gov/coverage/nebulizers-and-nebulizer-meds.html

According to a price check of pharmacies; 25 vials of it is not very expensive even at their cash price. I don't know if ADC would be able to beat a couple of the top prices. 

www.goodrx.com/albuterol

good lucK; that would be very scary to me to suddenly have my medication stopped! prayers are with you ((((HUG)))

[TerryDavid]

Jarca,

Thank you very much for your very informative reply. I will check into it further and see what I can find out. I know that the expense is relatively small compared to some of the other meds we have to take but it's the principle of the thing I guess. Perhaps another Pharmacy is in order. At this point I'm not sure, BUT I WILL find out.

Take care and thanks again.

Terry

[jarca]

ps. Terrydavid,
I was curious so I called my pharmacist & he said that regular medicare still pays for the albuterol med for nebulizers.
(my pharmacist doesn't take medicare, but he named a couple of big department store pharmacies that do---i got mine from my 02 supplier as i got my nebulizer from them also)

[David]

Let us know how it turns out TerryDavid

I have AARP supplemental health care and I have a prescription plan with another company.

I use a nebulizer 4 times a day.
One is Ipratropium Bromide and Albuterol Sulfate and the other is Budesonide Inhalation Suspension. The Budesonide I do two times a day and Ipatropium 4 times a day.

Then I use the Aonoro inhaler one time a day and Ventolin HFA when needed.

[joany]

I agree TerryDavid - someone, something, someplace messed up somewhere. There are so many twists and turns to Health insurance that it too often happens that a "t" wasn't crossed somewhere. Persistence is the word of the day - no matter what.

Based on the investigation Jarca did, it looks like there shouldn't be a problem. It may require a "note" from your Dr for continuation - to Medicare?, Advantage?, Supplemental?, Pharmacist? (I don't use a nebulizer so I can't be specific.) Hopefully this gets worked out right away. It seems it'd be unusual for something like a discontinuation to happen this far into the year - just thinking.

[TerryDavid]

Many thanks for all of the great responses. I really appreciate all the help. There will be some phones ringing off the hook Monday morning.

Terry

[TerryDavid]

Ok here's the deal. Apparently there was a mixup between the Pharmacy and Medicare. Imagine that. Anyway the Pharmacy was supposed to get an updated information paper regarding the medicine and they didn't get it. The rep from Medicare said that they have been dealing with quite a few of these mixups lately and hopefully they have everything resolved. I am supposed to get some sort of paper from them for verification purposes. We shall see.

Thanks to everyone for their valuable information on this problem. It is truly appreciated. This is a great website with some great people and I'm glad I found it.

Terry

[David]

I am glad to hear that it has been solved