Let the Buyer Beware!!

Recently I've been seeing a lot of advertising on television regarding Medicare payments for inhalers which are used by COPD patients, as well as others. I always thought that Medicare did not pay for prescription medications, but these ads make it appear that I was wrong. To find out, I asked an expert, a Registered Pharmacist, about what Medicare does and doesn't pay for. His answers may surprise you.

I use Combivent for my COPD and the ads show the box and the inhaler, just like I have in my night stand upstairs now. The ads also show other inhalers such as Albuterol. These are all the typical "metered dose" inhalers that we are all familiar with. From the ads, it appears that these are suddenly covered by Medicare and if I were older I would be able to get mine paid for by this federal insurance program that everyone is enrolled in. Great deal, right?

According to my information, the answer is wrong. MEDICARE DOES NOT PAY FOR INHALERS... plain and simple. They do not. Period. End of discussion. What they do pay for are the solutions needed for nebulizers. The pharmacist showed me the book used by all pharmacies to determine what Medicare will and will not pay for and nowhere in the book does it show payment of any kind for inhalers. There is talk that someday Medicare will pay for prescription medications, including inhalers, but as of now, this is only a dream in the minds of a few politicians and special interest groups. The entire congress has not approved this change in the Medicare laws, and it does not appear that they will anytime in the near future.

So how does this company get away with saying Medicare will now pay for these medications? The answer comes with a careful ear to what the advertisement really says. To paraphrase, it says that Medicare MAY pay for these items if you qualify. Of course, the opposite is also true... it may NOT pay for them and nobody qualifies... but if you did... yours would be paid. Nice bit of tricky language, don't you think?

Instead of paying, what too often happens is that the prescription is submitted to Medicare, knowing full well that it will be rejected. Due to the time involved, the consumer has used the medication already and when the billing comes back rejected the company passes the bill on to the consumer. Often, according to my source, the price is inflated and since the product has already been used, the customer has no chance of refusing to pay the higher price.

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