top of page

Prescription Drugs Covered Under Medicare Part B

Many people don’t realize that not all prescription drugs are covered under Part D of Medicare. Under certain conditions there are some outpatient prescription drugs covered under Medicare Part B. These are drugs you wouldn't typically give to yourself, like those you get at a doctor's office or in a hospital outpatient setting. The copay for the Medicare Beneficiary for drugs covered under Part B are typically between 0-20%. Some examples of Part B-covered drugs are:

Drugs used with an item of durable medical equipment (DME): Medicare covers drugs infused through DME, like an infusion pump or drugs given by a nebulizer, if the drug used with the pump is reasonable and necessary.

Some antigens: Medicare covers antigens if a doctor prepares them and a properly instructed person (who could be you, the patient) gives them under appropriate supervision.

Injectable osteoporosis drugs: Medicare covers injectable osteoporosis drugs if you meet certain conditions. In addition, Medicare will cover the home health nurse or aide to provide the injection if your family and/or caregivers are unable or unwilling to give you the drug by injection.

Erythropoiesis-stimulating agents: Medicare covers erythropoietin by injection if you have End-Stage Renal Disease (ESRD) or you need this drug to treat anemia related to certain other conditions.

Blood clotting factors: Medicare covers clotting factors you give yourself by injection, if you have hemophilia.

Injectable and infused drugs: Medicare covers most injectable and infused drugs when a licensed medical provider gives them, because these types of drugs aren't usually self-administered.

Oral End-Stage Renal Disease (ESRD) drugs: Medicare covers some oral ESRD drugs.

Parenteral and enteral nutrition (intravenous and tube feeding): Medicare covers certain nutrients if you can’t absorb nutrition through your intestinal tract or take food by mouth.

Intravenous Immune Globulin (IVIG) provided in home: Medicare covers IVIG if certain conditions apply.

Shots (vaccinations): Medicare B covers flu shots, pneumococcal shots, COVID-19 vaccines, Hepatitis B shots for certain people, and some other vaccines when they’re related directly to the treatment of an injury or illness.

Transplant / immunosuppressive drugs: Medicare covers transplant drug therapy if Medicare paid for your organ transplant. Medicare drug coverage (Part D) covers immunosuppressive drugs if Part B doesn't cover them.

Oral cancer drugs: Medicare covers some oral cancer drugs. If Part B doesn’t cover them, Part D does.

Oral anti-nausea drugs: Medicare covers oral anti-nausea drugs you use as part of an anti-cancer chemotherapeutic regimen if they’re administered before, at, or within 48 hours of chemotherapy or are used as a full therapeutic replacement for an intravenous anti-nausea drug.

Self-administered drugs in hospital outpatient settings: Under very limited circumstances, Medicare may pay for some self-administered drugs if you need them for the hospital outpatient services you're getting.


If you are someone who needs a prescription drug that is covered under Part B, be careful when choosing a Medicare Supplement or a Medicare Advantage Plan. It’s important to understand what the coverage is because some Part B covered drugs can be quite expensive.




4 views0 comments

Comments


bottom of page