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  • 09Jul

    Learn What Drugs Are Covered Under Medicare Parts A, B, and D

    Medicare basics, Prescription drugs

    The Centers for Medicare and Medicaid Services (CMS) recently revised their tip sheet explaining what prescription drugs are covered under Medicare Part A (hospital insurance), Medicare Part B (medical insurance), and Medicare Part D (prescription drug coverage). 

    If you or your clients have questions about which part of Medicare covers what drugs, this is a good place to start.

    In general, Part A only covers drugs that are administered as part of a beneficiary’s treatment while in a hospital or skilled nursing facility. Part B generally covers drugs that aren’t normally self-administered and instead are given as part of a doctor’s service. Coverage is usually limited to drugs that are given by infusion or injection. If the injection is self-administered or isn’t given as part of a doctor’s service, Part B generally won’t cover it.

    Part B also covers several other drugs, including: 

    • Various vaccination shots (flu shot, pneumococcal shot, Hepatitis B shot)
    • Some drugs used in infusion pumps and nebulizers
    • Osteoporosis drugs
    • Immunosuppressant drugs
    • Some oral anti-cancer drugs

    For a complete listing and explanation, see the CMS tip sheet.

    Part D provides comprehensive coverage for many generic and brand-name drugs and is offered through private Part D prescription drug plans. All Medicare drug plans must generally cover at least 2 drugs in each drug category, yet they can choose which 2 drugs to cover. In 6 drug categories, however, Medicare drug plans are required to cover all drugs. These 6 categories include: antidepressants, antipsychotics, anticonvulsants (drugs toprevent seizures), antiretrovirals (drugs to treat HIV/AIDS), immunosuppressants, and antineoplastics (anti-cancer drugs).

    Part D also covers most vaccination shots (except those covered under Part B).
    Medicare Part D does not cover drugs that are covered under Medicare Parts A and B. It also doesn’t cover the following drugs:
    • Benzodiazepines
    • Barbiturates
    • Drugs for weight loss or gain
    • Drugs for erectile dysfunction
    • Drugs for relief of cough and colds
    • Non-prescription drugs
    • Drugs used for cosmetic purposes or hair growth
    • Drugs used to promote fertility
    • Prescription vitamins and minerals, except prenatal vitamins and fluoride preparation products
    See the tip sheet, Medicare Drug Coverage under Medicare Part A, Part B and Part D, for more information. 
    See our section on Medicare Appeals for information on your appeal rights and how to file an appeal for drugs if coverage is denied. 
    For information on basic coverage under Medicare Parts A, B, and D, see our section Medicare Basics. 

    Posted by Karen Fletcher @ 9:52 am

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