Yes, some drugs are covered under Medicare Part B (medical/outpatient), but it’s only for certain prescriptions in limited situations. This is not an exhaustive list, but we will hit some of the common situations in this post. Full details can be accessed HERE.
Typically, prescription drugs covered under Part B would be drugs given to you by a medical professional in an outpatient office setting. Additionally, if a medication is given to you via a piece of durable medical equipment (DME), such as a pump or nebulizer, it might be covered under Part B.
Insulin Via An Insulin Pump
A perfect example of this is insulin administered through an insulin pump. You would normally take this medication in the convenience of your own home. The fact that it’s administered via the pump…the insulin, pump, blood sugar test strips, and blood sugar glucose monitors are all covered under Part B.
Check out our post on Medicare Coverage for Diabetics for more information.
Outpatient Infusions
Some Medicare beneficiaries need routine drug injections or infusions in a doctor’s office or outpatient facility setting. If these injections or infusions are medically-necessary and a Medicare-covered service, they likely run through Part B. An example would be chemotherapy.
Anti-Rejection Drugs (after organ transplant)
If you have End-Stage Renal Disease (ESRD or kidney failure), there can be significant medical and drug costs associated with your care. This is especially true after a kidney transplant as you may need to take transplant/immunosuppressive drugs for the rest of your life. Some of these immunosuppressive drugs are covered under Part B while others are covered under Part D. This can be challenging when trying to determine your expected out-of-pocket costs when in this situation. Work with Medicare or your Part D Prescription Drug Plan to verify which immunosuppressive drugs are covered under Part B and Part D.
Vaccinations
And don’t forget about vaccinations! There are some vaccinations provided by Medicare Part B at no cost to you (Flu, Hepatitis B, Pneumococcal, COVID-19).
Note: Starting in 2023, the Shingles vaccination & Tdap will now be covered 100% by your Part D Prescription Drug Plan or Medicare Advantage plan that includes Part D drug coverage.
Reference our full blog on vaccinations covered under Medicare Part B & Part D: Medicare & Vaccinations
Reference Links
www.medicare.gov
Medicare Prescription Drug Coverage (Outpatient)
Medicare & Vaccinations
