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 at this link.
Typically, prescription drugs covered under Part B would be drugs given to you by a medical professional in an outpatient office setting, not including drug samples. So, keep in mind that 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.
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 previous post on Medicare Coverage for Diabetics for more information.
Some Medicare beneficiaries need routine drug injections or infusions in a doctor’s office. If these injections or infusions are medically-necessary and a Medicare-covered service, they likely run through Part B.
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.
And don’t forget about vaccinations! There are some vaccinations provided by Medicare Part B at no cost to you (Flu, Hepatitis B, Pneumococcal).
Keep in mind: The Shingles vaccination is NOT covered by Part B, rather it’s a drug covered by your Part D Prescription Drug Plan, and will require a copayment.
If you need a drug not covered by Medicare Part B, don’t worry. Check your Part D Prescription Drug Plan (or Medicare Advantage Plan that includes Part D) to see if it’s on the plan’s formulary list of prescriptions.
As you can see, the answer to “Are all prescription drugs covered under Medicare Part B?” isn’t simple. But Medicare Mindset is here to help. Contact us to learn more.
Neither Medicare Mindset LLC nor its agents are connected with the Federal Medicare program.