CVS Caremark and the Pump: Jumping Through Hoops with Insurance Companies

Recently (as in a month and a half ago) my insurance company, Cigna, approved me for an insulin pump. It was covered 100% and I was told that my pump supplies would also be covered with a co-pay. With my new Animas Ping I got a whole bunch of infusion sets and cartridges. I'm going to be going to a training class next month to learn how to use it - I'm so excited! But I figured I should go ahead and figure out how to order supplies before then.

This past month my company moved to CVS Caremark - I didn't get any information on it besides the new cards and a short list of medications they cover. I went on their website and tried to look up Animas infusion sets/cartridges and saw that it was listed as not being part of my coverage plan.

So I called up Caremark and asked them if they covered pump supplies. The first person I talked to didn't know if it was covered and was going to transfer me to their Diabetes Team, however after 20 minutes on hold I opted to call them back directly. The "direct" line the customer service rep gave me? Right. It actually went to an international adoption agency.

I called back and got a woman who seemed to have no idea what an insulin pump was. When I told her I was trying to find out if they really weren't going to be covering infusion sets she said "Uhhh...what are those? Like ...insulin?". I had to explain to her what it was (details of how it worked exactly, etc) and she decided that those things were considered durable medical supplies and as thus would not be covered by Caremark.

At this point...I'm not sure who to ask. Their customer service staff is not trained on diabetic supplies and obviously cannot give me a straight answer (sorry, a little annoyed at being on the phone for an hour with these people!) and their Diabetic Team may or may not actually exist. That is why I come to you, insulin pumper forum! Have any of you dealt with Caremark? Are infusion sets and the such actually "durable medical supplies"? I'm still not sure on the pump lingo, especially when it comes to insurance companies so any insight for you all would be greatly, greatly, greatly appreciated! :)


ETA: I just got off the phone with Caremark. It was confirmed that they would not handle durable medical supplies. Cigna then confirmed that they would not be handling DMS, but that another third party vendor - Gentiva - would be handling it for them still. Problem solved!

But feel free to share experiences you've had trying to get prescriptions. Sometimes it helps to vent a little bit. :)

Tags: Animas, CVS, Caremark, Ping

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you will probably need to check with Cigna on Durable Medical Equiment (DME) coverage for it. The folks at Animas may be able to help you as well

Good Luck
Scott

PS I think we all love insurance so much that changing companies is an incredible joy since we get to experience a new and wonderful set of redtape! NOT
I know!

Since I posted that I called Caremark a third time and finally got someone who was familar with what I was asking for. So it was confirmed that Caremark wouldn't cover it. Woo! I then called Cigna and was informed that a third party company, Gentiva, would be covering "specialty medical supplies" for my company still. Which..I'm not sure why they didn't say that the first time I called? At any rate, I'm thrilled that I'll still be able to use my pump. :)
YAY!
Caremark does cover and carry diabetic supplies. The carry Metronic supplies only. I have a Cozmo pump. I have had to jump through hoops and have gotten no where with them. Be advised that you will have to have every shipment of supplies approved prior to shipment. Make sure to order your supplies early, extra early.
That's really good advice. I still have a bunch of pump supplies that came with the insulin pump initially. So I haven't had to re-order yet. Thank you! :)
I have to use the DME feature of my insurance. That is both good and bad. My DME purchases do not apply to my script deductible. However it does count against my plan deductible.

Rick
Do not be surprised if you are spending a lot more time on the phone fighting with Caremark over what is covered and what is not covered. Most of Caremark customer service knows my case history and does not have to look it up anymore.

Needles are covered under my policy but every time I order them I have to fight with Caremark because they send them in a different shipment and they need to have a RX for an injectible in the same order.

Make sure that you are specific about everything you order from them because they are bad about not fully reading the RXs and you end up with the wrong thing.

I am not a big fan of Caremark since Rite-Aid bought them out.
As i was reading your post, I was about to say that Caremark deals with prescription medicines (at least for me). Pump supplies fall under durable medical and should be part of your insurance coverage, not your prescription plan.

I just started getting test strips through Caremark, and my initial call there was a little weird (felt like I was talking with people who had never dealt with any kind of medical ailment, much less diabetes!). I did receive my supplies within 2 weeks, though, and so far they've been pretty good.

So, you still may be able to get your testing supplies through them, as long as your doc writes a prescription:)
Right, what I had written above was basically my process as a first time pumper learning exactly what I was going to need to do in order to obtain the supplies specific to the pump. I've always gotten my supplies from the pharmacy. In fact, I was going to continue to get my strips and insulin through my local pharmacy. Maybe I'm nuts, but I like knowing that if I was in a pinch I could go down the pharmacy to do my re-fill. I tend to forget to do them until the last minute. So, we'll see how this mail order bit goes. Heh.

It looks like I will be calling the order into Animas, who in turn sends it to geneva, who in turn sends it back to Cigna who bumps the payment back to Animas. I can only hope that that particular process makes some kind of financial sense for them, somehow. But I fear it doesn't.
I had the same issue. I have caremark, and blue cross blue shield of il. yet henry ford health systems takes care of my supplies... lol
Just ran across this conversation... I have a twist. I now have Caremark for my prescriptions (mail order/3mo supply) and BCBS of Illinois. I managed to hurry through the purchase of my pump and intial supplies in December '08 in order to have them covered at a lesser cost under my major medical durable supplies; BUT....it was under Medco. Everything changed in January when my insurance switched to ta da...Caremark. I did have a problem when I placed my first order for the test strips for my PDM-- OmniPod. It appeared that Caremark didn't carry the test strips that I needed for my pump-- Freestyle strips or lancets. I called and requested a superviser and got the same answer. Then I was told to send in the prescription and to "see what happens." @#%$^!!! To my amazement...I did receive the test strips in record time. Praise be!

After viewing the replies here...I need to call my rep and/or Insulet and advise them of the change once again and verify the next shipment. The term durable medical supplies is familiar to me since that's where the coverage for my nebulizer comes from; and I was told that my insulin pump and supplies (pods) was covered under that part of my insurance as well. I still have a box and 3/4 of pods; hopefully it won't take that long to sort it out. I was told that the transition would be seamless..we'll see. Perhaps, BCBS covers the pump(s) or not..right Sarah?
We have had the cozmo for four years and cigna paid for everything including suppies, we use the insilet infusion set from animas with no problems. I thought it was called gentiva carecentrix . I guess it has changed. we are now thinking about getting the ping . Hopefully we will have no problems.

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