From Shirlee Zerkel: Advice for retirees needing ostomy supplies

From Shirlee Zerkel, September 5, 2008
Subject: Re: Another question!

STRS retirees, I have asked these questions about ostomy supplies because I know they are covered by Medicare B and there are people out there who can not function without these supplies if they have had an ostomy due to rectal or bowel cancer or some other bowel surgery.

Both ostomy and diabetic supplies are listed on the Medicare website as Durable Medical Equipment. Diabetic supplies are supplied by Express Scripts at no co-pay but ostomy supplies are not. I want to know why, for those who live with this need. If you need these ostomy supplies, please question Express Scripts or STRS.

Shirlee Zerkel

Sandy Knoesel to Shirlee Zerkel, September 5, 2008
Subject: Re: Another question!

Pharmacy Benefit Managers (PBMs) typically negotiate and hold contracts with manufacturers of diabetic supplies; so, even though these supplies are considered DME under Medicare, the coverage is provided through the prescription benefit. Another way to look at this is that diabetic supplies monitor how the body is functioning; they do not replace a body function. I hope this information is helpful.

Sandy Knoesel