Medicare Part A and Part B (the two parts of what’s often called Original Medicare) don’t typically cover prescription drugs. However, Medicare Part B can cover select drugs that are administered by a health care professional in a doctor’s office or other outpatient setting.
Medicare Part A offers coverage for certain drugs administered in a hospital, skilled nursing facility or while in hospice.
In this guide, we explain Part B drug coverage, and we offer some alternative ways you may be able to find Medicare prescription drug coverage, either through a standalone Medicare Part D prescription drug plan (PDP) or a Medicare Advantage Prescription Drug (MA-PD) plan.
Speak with a licensed insurance agent
Medicare Part B is the medical insurance part of Original Medicare. While Part B doesn’t typically cover the types of prescription drugs you might get at a retail pharmacy like CVS or Walgreens, it can help pay for other drugs that are more difficult to administer.
Below is a list of the types of drugs Medicare Part B covers.
Medicare Part B covers durable medical equipment (DME), such as wheelchairs and walkers. But DME also includes items that are used to administer drugs, like an infusuion pump or nebulizer. If the item of DME is covered by Part B, the drug that pairs with the item will also be covered provided that the drug used is considered medically necessary.
Part B covers some antigens when prepared by a doctor and administered by a properly trained person (which can include the patient).
Women with bone fractures who meet all other coverage criteria can receive Part B coverage for an injectable drug to treat osteoporosis.
Medicare Part B pays for this drug is you have End-Stage Renal Disease (ESRD) or need the drug to treat anemia related to certain other conditions.
Part B will cover blood clotting factors given by injection if you have hemophilia.
These may include drugs to treat inflammatory bowel disease, psoriasis, rheumatoid arthritis and more.
Medicare Part B pays for some oral ESRD drugs when other ESRD coverage criteria are met.
Part B offers coverage for intravenous and tube-fed nutrients if you are unable to absorb proper nutrients orally or through your intestinal tract.
Medicare Part B covers IVIG drugs if you’ve been diagnosed with primary immune deficiency disease.
Part B provides coverage of flu, Hepatitis B and pneumococcal shots along with other select vaccines when directly related to the treatment of an injury or illness.
Medicare Part will cover the cost of your transplant drug therapy if the transplant itself was covered by Medicare.
Part B covers some orally ingested drugs to treat cancer. And as new cancer drugs are developed, Part B may adopt coverage for those as well.
Anti-nausea drugs that are used as part of a chemotherapy treatment program are covered by Part B when certain circumstances are met.
Part B may cover the cost of some self-administered drugs if needed when receiving hospital outpatient services.
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Drugs covered by Medicare Part B are typically covered the same way other Part B services and items are covered. That means the annual Part B deductible applies ($226 in 2023) followed by a 20% coinsurance of the Medicare-approved amount.
Preventive vaccinations are covered in full by Part B, and the deductible does not apply.
Most medically necessary prescription drugs filled at a pharmacy are covered by Medicare Advantage Prescription Drug (MA-PD) plans and Medicare Part D plans.
Medicare Advantage and Medicare Part D plans are sold by private insurance companies. Call to speak with a licensed insurance agent to learn about Medicare plans available in your area that include prescription drug coverage.
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.