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3 Responses to Federal Legislative Branch

  1. Pingback: U.S. Health Policy Gateway

  2. I need to know if Federal Law requires Medicare Suppliers who take Mecicare Assignment to provide and file a claim for a patient whose Medicare Insurance is in place for Medicare Part A and B..and that Medicare Manual 2010 says on pages 25, 35 and 47 that the inhalant I need for my nebulizer (Xopenex) will be paid 80% by Medicare and 20% by my supplemental insurance…my insuance will pay..but providers will not get it for me and file the claim..such providers as: Arpria Pharmacy, Prescription Solutions who accept assignment, and a local Pharmacy, Ford’s Pharmacy in Spartanburg, S.C. who I called on Friday. They tell me the reason they won’t get it for me and file the claim is becase the Medicare reimbursement is not enough for they to make a profit and it costs them money. This should be resolved between insurance & provider & the company who makes Xopenex, Sepracor, not put on a big burden for the patient who needs this specific drug..and cannot take generic or substituion such as albuterol..according to my dr. that drug is not effective for my condition and affects my heart disease..I have had open heart surgery..albuterol makes my heart race and put me in the hospital with complications in January..costing Medicare more money than necessary, if I had been using correct inhalant..Simple problem, no solution because of greed by pharmaceutical companies..I will contact local television which likes to help senior citizens, and get local publicity on this is Persons who are supposed to help, do not. Thank you, Shirley Pitman Senior Citizen in Need of Help

    • Chris Conover says:

      To my knowledge, no one is breaking the law in this instance. Pharmacies are not obliged to sell prescriptions at a loss, so the fundamental problem is that Medicare reimbursement is too low for this particular drug. Since you already have Part D, I would see if your drug plan covers this medication. If it doesn’t, then you might find a different plan that does and switch to that plan when you next get a chance to do so.

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