Medicare Medical Insurance (Part B) drugs are medications covered under Part B.
Unlike the drugs obtained through Medicare Prescription Drug Plans (Part D) coverage, which are usually self-administered, Part B drugs are often administered by a physician or under a physician’s close supervision in the doctor’s office or in hospital outpatient departments. They may also be administered through Durable Medical Equipment (DME), such as respiratory drugs given through nebulizers. Examples of self-administered Part B drugs are immunosuppressive drugs and some oral anti-cancer drugs.
By law, Part B cannot pay for drugs that are covered under Medicare Hospital Insurance (Part A) or Part D.
Part B drugs are subject to the yearly Part B deductible, which means that beneficiaries have to pay the deductible before Medicare pays its share.
These are some of the drugs covered by Part B (all are provider-administered unless otherwise noted):
- Flu shot
- Pneumococcal shot
- Hepatitis B shots
- Other shots, including vaccines related to injury or illness
- Blood and blood drugs
- Drugs used with Durable Medical Equipment (DME), such as infusion pumps and nebulizers
- Injectable drugs
- Osteoporosis drugs, if the woman with osteoporosis is unable to self-administer the drug
- Some antigens
- Erythropoiesis-stimulating agents
- Immunosuppressive drugs for beneficiaries who have had a Medicare-covered organ transplant
- Oral anti-cancer drugs
- Oral anti-nausea drugs
- Oral End-Stage Renal Disease drugs
- Parenteral and enteral nutrition (intravenous and tube feeding)
- Separately billable drugs provided in hospital outpatient departments (if median cost to administer exceeds $50)
Part B Drug Costs
Part B drugs are expensive for Medicare; the Centers for Medicare & Medicaid Services (CMS) spent nearly $19.5 billion on Part B drugs in 2010.
According to a recent Government Accountability Office (GAO) report, spending on Part B drugs is high either because they are used by a great number of beneficiaries or because the prices of the medicines are high.
Payment rates for Part B drugs are based on private market prices. These are determined when drug manufacturers submit data to the CMS, which then uses the data to calculate annual sales prices.