Outpatient Prescription Drugs

Examples of outpatient prescription drugs covered by Part B include the following:

• Drugs that require durable medical equipment (DME) to use. Medicare covers drugs infused through DME, such as an infusion pump or nebulizer.
• Some antigens: Medicare helps pay for antigens if they are prepared by a physician and administered by a properly trained person (which could be you, the patient) under appropriate supervision.
• Injectable Drugs for Osteoporosis: Medicare helps pay for an injectable drug if you are a woman with osteoporosis who meets the criteria for the Medicare home health benefit and you have a bone fracture that a doctor certifies is related to postmenopausal osteoporosis. A physician must certify that you are unable to administer the injection yourself or learn how to administer the medication by injection. The nurse or home health aide will not be covered to administer the injection unless the family and/or caregivers are unable or unwilling to administer the medication by injection.
• Erythropoiesis-stimulating agents: Medicare helps pay for erythropoietin by injection if you have end-stage renal disease (ESRD) or if you need this drug to treat anemia related to certain other conditions.
• Blood clotting factors: Medicare helps pay for clotting factors given by injection if you have hemophilia.
• Injectable and infused drugs: Medicare covers most of these when administered by a licensed health care provider.
• Oral drugs for end-stage renal disease (ESRD): Medicare helps pay for some oral drugs for ESRD if the same drug is available in injectable form and the drug is covered under the Part B ESRD benefit.
• Parental and internal nutrition (intravenous and tube feeding): Medicare helps pay for certain nutrients if you are unable to absorb nutrition through your intestinal tract or take food by mouth.
• Intravenous Immune Globulin (IVIG) provided at home: Medicare helps pay for IVIG if you have a diagnosis of primary immune deficiency disease. A physician must decide if it is medically appropriate for IVIG to be given in your home. Part B covers IVIG itself. However, Part B does not pay for other items and services related to your receiving IVIG at home.
• Injections (shots): Medicare covers flu shots, pneumococcal vaccines, hepatitis B vaccines, and certain other vaccines when they are directly related to the treatment of an injury or illness.
• Transplant/immunosuppressive drugs. Medicare covers transplant drug therapy if Medicare helped pay for your organ transplant. Medicare won't pay for any services or items, including transplant drugs, for patients who aren't entitled to Medicare.
• Oral Cancer Drugs: Medicare helps pay for some oral cancer drugs that you take by mouth if the same drug is available in injectable form or if the drug is a prodrug of the injectable drug. A prodrug is an oral form of a drug that, when swallowed, breaks down into the same active ingredient found in the injectable drug. As new oral cancer drugs become available, Part B may cover them.
• Oral Anti-Nausea Drugs: Medicare helps pay for oral anti-nausea drugs used as part of a cancer chemotherapy regimen if given before, during, or within 48 hours after chemotherapy or if used as a complete therapeutic replacement for an intravenous anti-nausea drug.
• Self-administered drugs in outpatient hospital settings: Medicare may pay for some self-administered drugs, such as drugs given through an IV. Medicare pays for these drugs if you need them for the outpatient hospital services you are receiving.