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).
- 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