A Texas man with chronic obstructive pulmonary disease (COPD) died before he could receive a breathing medication his lung specialist prescribed in June, after his pharmacy told him the order was held up by an insurance issue, according to KFF Health News. Kenney Blewett of Kyle, Texas, died by suicide on June 7, five days after the prescription was written, the outlet reported Oct. 2, citing his wife, Cindy.
Suicide rarely has a single cause, and no one can say what would have changed his outcome. But the unresolved prescription is a warning for older Americans who rely on Medicare for breathing treatments. A routine pharmacy message can leave a seriously ill patient and a caregiver without a clear answer, or a clear person responsible, during the days when treatment may matter most.
A Prescription Lost Between Medicare's Coverage Lines
According to KFF Health News, Blewett had been diagnosed with lung disease more than a decade earlier, but this year he began having flare-ups that left him feeling he could not breathe. His wife said he described them as "the scariest thing in the world."
On June 2, his pulmonologist prescribed a new medication. Two days later, Walgreens emailed that the drug was delayed "due to an insurance issue that we're working to resolve." When Cindy called the pharmacy, she said an employee told her the prescription required prior authorization, and staff "kept saying different things."
The confusion was rooted in how Medicare pays for this type of drug. Because the medicine was a liquid inhaled through a nebulizer machine, KFF Health News reported, it was one of the relatively few covered under Medicare Part B's durable medical equipment benefit, not Part D. Blewett had Original Medicare, a Wellcare Value Script Part D plan and a Medigap policy, which does not require prior authorization.
A Walgreens supervisor later said the prescription went to Part B without a required diagnostic code and that a request was faxed to the doctor's office, Cindy recalled. An employee at the practice told her it never saw that fax. Medicare told her it had no record of the drug being billed to his Part B coverage, she said.
Walgreens said it "cannot comment on matters involving specific individuals." Centene, Wellcare's parent company, would not answer questions, and the pulmonologist did not respond to KFF Health News.
A Coverage Gap That Even Pharmacies Misread
Medicare's own rules help explain the confusion. Medicare.gov's nebulizer coverage page says Part B covers nebulizers, and some medicines used in them when considered reasonable and necessary, for use at home. After the Part B deductible, patients usually owe 20% of the Medicare-approved amount.
"Medicare has gotten to be so complex and convoluted over the years," Mike Hess, senior director of advocacy and regulatory affairs at the nonprofit COPD Foundation, told KFF Health News. He said even medical office staff and pharmacy employees often misunderstand the nuances.
"It's just gotten completely out of hand," said Matt Toresco, CEO of Archō. A KFF Health Tracking Poll conducted in January found about two-thirds of adults call insurance delays and denials a major problem.
The CDC says nearly 16 million U.S. adults have COPD. Texas is also one of six states in a Medicare pilot, launched in January, that uses technology including artificial intelligence to help review prior authorization requests in Original Medicare. KFF Health News did not tie Blewett's prescription to that pilot.
Steps for Patients and Caregivers When a Refill Stalls
When a pharmacy flags an insurance problem, patients and caregivers can ask a direct question first: is this drug being billed to Part B or Part D? Some nebulizer drugs fall under Part B, so a delay may signal a billing mix-up rather than a true refusal. Ask what is missing, such as a diagnosis code, and who was asked for it.
Then confirm with the prescriber's office the same day that it received the request, and call 1-800-MEDICARE to check whether a claim was submitted. For Part D drugs, patients or prescribers can request a coverage determination, and CMS rules require plans to decide within 72 hours for standard requests and 24 hours for expedited requests when waiting could seriously harm health.
State Health Insurance Assistance Programs, known as SHIP, offer free one-on-one Medicare counseling. Caregivers can also ask the doctor whether a short-term alternative is appropriate while the issue is resolved. Patients should not stop prescribed treatments without talking with a clinician.
Breathing Emergencies and Emotional Strain Both Need Fast Help
During a gap in treatment, families should know when a flare-up needs attention. MedlinePlus advises contacting a provider if breathing keeps getting harder, faster, or shallow after following a COPD action plan, or with bluish lips or fingertips, chest pain, confusion, or trouble speaking in full sentences. MedlinePlus also says to call 911 or go to the emergency room for a rapid increase in shortness of breath.
Living with a progressive lung disease can also take a heavy emotional toll. If a loved one talks about feeling hopeless or being a burden, calling or texting 988 connects them to trained counselors at any hour. Depression can be treated, and a clinician can screen for it.
Cindy Blewett still does not know what went wrong. "Short of getting attorneys involved, I'm not sure how to find out what really happened," she said. A second COPD medication ordered from the manufacturer arrived several weeks after his death, she said. "He was hopeful that it would work. I wish we had the chance to find out," she said of the delayed drug.
For Medicare households, the most useful steps are practical: ask which part of Medicare should pay, follow up the same day, and request a fast review when a delay could affect breathing. MedicalDaily will follow any response from Walgreens, Centene, or Medicare.
Key Questions Answered
What happened to the Texas COPD patient?
KFF Health News reported that Kenney Blewett of Kyle, Texas, was prescribed a nebulizer medication on June 2, but Walgreens said it was delayed by an insurance issue. He died by suicide on June 7. The companies involved have not explained what went wrong.
Why are nebulizer drugs confusing under Medicare?
Some nebulizer medicines are covered under Part B as part of durable medical equipment, not under Part D drug plans. That split means pharmacies, doctors and patients can submit claims to the wrong place or miss required details, such as a diagnosis code.
What should I ask if my pharmacy flags an insurance issue?
Ask whether the drug is billed to Part B or Part D, what information is missing and who was contacted. Then confirm with your doctor's office that it received the request, and call 1-800-MEDICARE to check the claim.
Can I get a faster decision on a needed drug?
Yes, for Part D drugs. You or your prescriber can request an expedited coverage determination, which plans must decide within 24 hours when waiting could seriously jeopardize your health.
Where can Medicare patients get free help?
State Health Insurance Assistance Programs provide free, unbiased Medicare counseling. You can find your state's program through the SHIP national website.
Which COPD symptoms need emergency care?
MedlinePlus says to call 911 or go to the emergency room for a rapid increase in shortness of breath. Worsening breathing, bluish lips or fingertips, chest pain, confusion or trouble speaking in full sentences are reasons to contact a provider promptly.
Where can someone in emotional distress find help?
Call or text 988 to reach the 988 Suicide & Crisis Lifeline, which offers free, confidential support 24/7. Online chat is also available through the Lifeline's website.
Published by Medicaldaily.com
