What Drugs Does Medicare Part B Cover?
- Medicare Part B can cover a limited number of drugs and medication treatments. Learn about the types of medications covered by Part B and how they differ from those covered by Medicare Part D.
Medicare Part B does not typically cover the types of prescription drugs you get at a retail pharmacy such as CVS or Walgreens. Medicare Part B is the medical insurance portion of Original Medicare, which also includes Medicare Part A hospital insurance coverage.
Medicare Part B can cover drugs that are administered by a doctor, nurse or other health care provider in an outpatient setting such as a doctor’s office, however. These types of drugs can include certain injectable drugs, some vaccinations, cancer drugs and more.
What Parts of Medicare Cover Prescription Drugs?
Medicare Part D prescription drug plans are a type of private Medicare coverage that cover many commonly prescribed drugs. Part D plans can be sold by private insurance companies as standalone prescription drug plans – or PDPs – that you can combine with your Original Medicare coverage.
Another type of private Medicare health plan is Medicare Part C, also called Medicare Advantage. The vast majority of Medicare Advantage plans include Part D prescription drug coverage as a part of the plan benefits. Medicare Advantage plans essentially replace your Original Medicare coverage, and many plans offer additional benefits that Original Medicare (Part A and Part B) doesn’t cover, such as prescription drugs, hearing, vision, dental and more.
In this review, we outline what drugs are covered by Medicare Part B, and we detail some of the additional options you may have to find Medicare prescription drug coverage.
A List of the Types of Drugs Covered by Medicare Part B
Drugs that are covered by Medicare Part B include the following.
Medicare Part B covers certain vaccinations, including those for:
- Pneumococcal (pneumonia)
- Certain other vaccines when needed to treat an injury or illness
Drugs That Are Used With Durable Medical Equipment
Durable medical equipment (DME) includes things like walkers, wheelchairs and other supplies used in the home and are covered by Medicare Part B. Durable medical equipment can also include things like nebulizers, infusion pumps and other equipment that pair with medication.
Medicare Part B covers drugs that are infused through durable medical equipment. That can include insulin when the use of an insulin pump is determined to be medically necessary.
Medicare Part B covers certain antigens that are prepared by a doctor and given by a properly instructed person under the appropriate supervision. The patient can qualify as the properly instructed person if they have been given the necessary instructions by a doctor or other qualified health care provider.
Injectable Osteoporosis Drugs
Women with osteoporosis who qualify for home health benefits and certain other criteria can have injectable osteoporosis drugs covered by Medicare Part B. The drug must be injected by a home health nurse or aide or caregiver.
Part B will cover an erythropoietin injection for those with End-Stage Renal Disease (ESRD) or anemia related to certain other conditions.
Oral Drugs for ESRD
If an oral version of an ESRD drug is available and the injectable version is covered by Medicare, Part B will provide coverage of the oral drug.
Blood Clotting Factors
Part B beneficiaries with hemophilia can have blood clotting factors covered when they’re administered as self-injected drugs.
Immunosuppressive drugs may be covered by Part B when an organ transplant also qualifies for Medicare coverage.
Certain Cancer Drugs
Certain cancer drugs that are taken orally are covered by Part B when the same drug is also available in injectable form.
Drugs used to treat nausea resulting from chemotherapy treatment are also covered.
Parenteral and Enteral Nutrition
Part B provides coverage for intravenous and tube feeding for those who are unable to absorb nutrition through their intestinal tract or take food by mouth.
Intravenous Immune Globulin (IVIG)
A Part B beneficiary with primary immune deficiency disease can have IVIG treatment covered in their home.
What Infusion Drugs Are Covered by Medicare Part B?
Infusion drugs are those that are administered intravenously through a needle or catheter. To be covered by Medicare Part B, the drugs must be non-oral or biological, administered through an IV or applied under the skin for a period of at least 15 minutes. The drugs must be considered “reasonable and necessary” and not self-administered.
Some common infusion drugs that may be covered by Medicare Part B include:
If you would like to check Medicare Part B coverage of a specific drug, call 1-800-MEDICARE (1-800-633-4227) and speak to a representative concerning your medications and the coverage requirements surrounding it.
Does Medicare Part B Cover Chemotherapy Drugs?
Medicare Part B covers several chemotherapy drugs that are administered through the vein in an outpatient setting.
Part B coverage includes certain oral and intravenous drugs along with anti-nausea drugs to offset the symptoms of chemotherapy. In fact, chemotherapy and other cancer-treating drugs account for the majority of units of Medicare-covered drugs that are thrown away or otherwise discarded by health care providers.
Chemotherapy drugs can be expensive, which is why Part B may not cover all of them. Further coverage for chemotherapy drugs can be found in Medicare Part D or Medicare Advantage plans that include prescription drug coverage.
What Is the Difference Between Part B and Part D Drugs?
Medicare Part B covers drugs that usually are not self-administered. That is, they are given by a doctor or other health care professional in a doctor’s office, other outpatient facility or at home by a home health aide or caregiver. These drugs are generally administered by infusion or injection.
Medicare Part D covers drugs that are prescribed by your doctor and then filled at a pharmacy (or delivered to your home) and are self-administered. These can include both oral and injectable drugs.
As mentioned above, Part B is one of the two parts of Original Medicare (along with Part A). Original Medicare is publicly funded and provided by the federal government. Medicare Part D prescription drug plans and Medicare Advantage plans that include drug coverage are sold by private insurance companies, though they are regulated by the Centers for Medicare & Medicaid Services (CMS).
Medicare Part D coverage can exist as a standalone plan (PDP) or as part of a Medicare Advantage plan (sometimes called a Medicare Advantage Prescription Drug Plans, or MA-PD).
Which Medications Would Not Be Covered Under Medicare?
Medicare typically does not cover services or items that are not considered medically necessary, and that extends to medications. Non-prescription drugs and drugs used for cosmetic purposes are not covered by any part of Medicare. The list of medications not covered by Medicare also includes drugs for sexual dysfunction or fertility and anything that is not FDA-approved.
While over-the-counter medications such as cold medicine are not covered by Original Medicare, they are covered by a growing number of Part D and Medicare Advantage plans.
Where Do I Find a List of Drugs Covered by Medicare Part D?
Medicare Part D drug coverage can vary from one plan to another. The list of drugs covered by a Part D plan is called a “formulary.”
Part D plans typically cover a wide range of drugs. And while the formularies can vary by plan, there are certain drugs that must be covered by every Part D plan, such as cancer drugs or HIV/AIDS medications.
Part D plans cover both generic and name brand drugs and typically do so at different “tiers.” Common generic drugs are typically placed into a lower tier and typically covered at a lower cost, while rare or brand name drugs are placed into a higher tier and may require more costs to the beneficiary.
Each plan’s formulary can usually be found along with its summary of benefits. When shopping for a Part D plan (or a Medicare Advantage plan with prescription drug coverage), the drug formulary should be listed alongside the other plan details.
It’s important to note that a plan’s formulary can change every year as drugs may be added to or dropped from a particular plan’s benefits, or a drug may be moved to a different coverage tier.
If there is a specific drug you want to obtain coverage for, contact a licensed insurance agent and they will be able to gather up the plans available in your area that provide coverage for your medication.