AARP Medicare Advantage Plan 2 is not covering my insulin for $35/month

[MargaretZ599679]

In February I had to pay $338 for for a 3 month supply of Humalog insulin. I was told the plan was not yet updated and would recieve a refund for the excess amount. But now I a m down to my last couple days of insulin in my pump and the plan still is not going to cover it for $35. I will have to pay $352 at Walgreens for this drug that I cannot live without. I have been trying to resolve this for 2 months of numerous calls to UHC, Medicare, Walgreens and my doctor's office. I have no choice but to overpay again and feel I have been duped by UHC. Since AARP is a sponsore for this insurance, you should feel some responsibility for making sure that the insurance company keeps its committments. 

[GailL1]

@MargaretZ599679 

Insulin for an Insulin Pump is covered by Medicare Part B, NOT by Medicare Part D.

Initially the $ 35 coverage was issued for only Part D insulin.  But beginning on July 01, 2023, Part B insulin for your pump will be covered for the $ 35 limit.

Here is the info from Medicare.gov -  NOTE ITEM # 6

Medicare.gov - 7 Things to Know about Medicare Insulin Costs

The same rule applies to a Medicare Advantage Plan since they distribute your Part B coverage.

[MargaretZ599679]

I have done all this to no avail. UHC will not even reimburse me for my overpayment in Feb. Since going on Medicare 5 years ago my insulin and pump and supplies have been coverd by part B but this year I can't get that to go through. It has been exhausting dealing with Medicare and UHC. I know that if I could hold until July 1 I can get my insulin for $35/mo but I would not last till then and you probably know that would be fatal.  What I want at this point is to make formal complaints to both of them and to Dept. of Health and Human Services and have tried, but no response. I thought since AARP is a sponsor they might pay attention After all, they boast about helping to get the insulin affordability act passed, but I do not see a way to get AARP's attention either. Is there a link to their complaints dept. that I am not seeing?

[GailL1]

I am sorry but this is a government initiation problem - the way that the government began the new program.  Until July 01, 2023, you will have to deal with it the way you have always done before now under the MA coverage with your coinsurance.  AARP cannot change the way the program has been set up by CMS - your MA plan is just following the rules/guidelines put out by CMS in how this  Medicare insulin program will work.  

Whenever a new government program is initiated, CMS sets the rules and the timelines - so July 01, 2023 is the beginning date for insulin used in a pump to be covered by the $ 35 program.

CMS.gov - Frequently Asked Questions
about Medicare Insulin Cost-Sharing Changes in the Prescription Drug Law (Updated January 2023)

From UHC - 2023 Inflation Reduction Act - FAQ -

See page 2 - under the FAQ of DOES THE IRA COVER PART B INSULIN AND PUMPS?

You can complain but the program date for Part B insulin coverage has been set for July 01, 2023 by CMS; so your complaint may just be met with with the reintegration of this date - July 01, 2023.