Medicare Drugs Part B Vs. Part D

Medicare is health insurance available for the elderly and disabled populations of the United States. It is federally administered and offers comprehensive, affordable coverage. Occasionally, drugs can be billed to Medicare incorrectly, triggering a denial of coverage. Understanding how Medicare drugs are covered can help beneficiaries protect themselves from this inconvenience.

Definitions

• Part B is Medicare’s outpatient medical benefit. It typically covers doctors’ visits or any outpatient procedures or supplies. Part B is available through both traditional Medicare and Medicare private health plans known as Medicare Advantage. Part D is the Medicare prescription drug benefit. It is available through private health plans. Both of these benefits are optional.

Physician-Administered Part B Drugs

• Typically, Part B covers drugs that are administered by a physician or another health care professional such as a nurse. This includes drugs that require an outpatient visit such as anticancer and chemotherapy drugs, some immunosuppressant drugs and dialysis drugs.

Self-Administered Part B Drugs

• Some Part B drugs are self-administered, meaning that they are taken home by the patient and taken like any other prescription. This includes some immunosuppressant drugs that aren’t physician-administered and some anticancer drugs. This also includes drugs that are used through durable medical equipment, such as respiratory drugs.

Vaccines and Immunizations

• Vaccines and immunizations fall under both Part B and Part D. It is billed under Part B if the beneficiary is receiving the vaccine or immunization in order to treat a condition or to prevent a condition he is at risk for (influenza or hepatitis B, for example). Routine booster shots, however, are billed under Part D. For example, if someone steps on a rusty nail and requires a tetanus shot, this would be a Part B drug. If the beneficiary is getting a routine tetanus booster shot, then it is billed under Part D.

Part D Drugs

• Part D can cover all self-administered drugs that are Medicare-approved. Part D plans must cover most antiretrovirals, antidepressants, antipsychotics, anticonvulsants, anticancer agents, antineoplastics, and immunosuppressants (that are not Part B drugs). Part D, however, cannot cover any drugs that are excluded by Medicare law (barbiturates, benzodiazepines, drugs to treat anorexia, weight loss drugs, weight gain drugs, drugs for colds and coughs, vitamins and minerals, and over-the-counter drugs), drugs that are considered ineffective by the U.S. Food and Drug Administration (FDA) or drugs used off-label (for a purpose that is not FDA approved). Each Part D plan has a different formulary and may not cover the same drugs.