Medicare Part B Offers Limited Prescription Coverage

Medicare Part D is Not the Only Way to Get Your Medicine

Part B IV medication infusion
Part B may cover your outpatient IV medications. Mark Harmel/Photographer's Choice/Getty Images

Before Medicare Part D offered coverage in 2006, your medications were either covered by Medicare Part B or out of your own pocket. The Part B benefit is limited to specific medications and medical conditions which unfortunately do not offer help to the majority of people.

Covered Part B Medications By Mouth

  • Antigens. These medications may be appropriate to boost the immune systems of people with certain medical conditions but only if they are prepared by a physician, usually an allergist.
  • Anti-nausea drugs. These oral medications may be used as part of a chemotherapy regimen as long as they are a replacement for intravenous anti-nausea medications. These medications must be administered within 48 hours of chemotherapy treatment.
  • Cancer drugs. These oral medications may be covered if they are equally as strong as injectable forms of the drug. Alternatively, they may be in a form that is more active than the injectable drug.
  • Drugs for end-stage renal disease (ESRD). Certain oral medications may be covered if they are also available in injectable form.
  • Immunosuppressive drugs. These medications will be covered if you had an organ transplant while under Medicare. As long as your Medicare benefits continue, Part B will cover these medications. Believe it or not, people who have a successful kidney transplant may lose their Medicare benefits after 36 months, unless they are eligible for Medicare in other ways.

    Covered Part B Medications By Injection

    • Antigens. See above.
    • Blood clotting factors. These medications are covered for patients with hemophilia if they administer these medications themselves.
    • Drugs administered through an infusion pump. Medications that require the use of an infusion pump and that are administered by a medical professional are covered by Part B.
    • Erythropoiesis–stimulating agents. These medications treat anemia caused by end-stage renal disease and other specific medical conditions.
    • Intravenous immune globulin. This medication may be administered at home for patients with a diagnosis of primary immune deficiency disease.
    • Intravenous nutrition. People who are unable to take food by mouth or who are malnourished due to diseases of the gastrointestinal tract may receive certain nutrition solutions by IV.
    • Osteoporosis drugs. Women with fractures caused by post-menopausal osteoporosis may be prescribed injectable medication for use at home. Other fractures or causes of osteoporosis do not qualify for the benefit.
    • Vaccines. Some but not all vaccines are covered under Part B. Shingles vaccine, for example, is covered by Part D.
      • Hepatitis B vaccination is only offered to those considered at risk. This includes people who have diabetes, end stage renal disease or hemophilia. Healthcare workers and those who have a history for blood transfusion are also at higher risk for hepatitis B.
      • Influenza vaccination is covered once every year. 
      • Pneumococcal vaccination is covered once after the age of 65.
      • Tetanus vaccination is covered by Part B in the case of trauma or emergency. Preventive tetanus vaccination, however, is covered by Part D.

      Other Covered Part B Medications

      • Medications used in nebulizer machines. Inhaled medications that require the use of a nebulizer machine are covered under Part B.
      • Tube feedings. Similar to intravenous nutrition, tube feedings are covered as nutrition for those who cannot take food by mouth.

      Part B and Part D are Mutually Exclusive 

      Medicare does not want to pay for something more than once. If a medication is covered by Part B, Part D will not cover it. If a medication is not covered by Part B, it could be covered under your Part D plan depending on your formulary. 

      Continue Reading