Part A covers drugs you need during a Medicare-covered stay in a hospital or skilled nursing facility.

Part B covers most drugs administered by your provider or at a dialysis facility. The provider or facility must buy and supply the drugs, though. Part B also covers some outpatient prescription drugs, like oral cancer drugs used in chemotherapy.

Part D covers most outpatient prescription drugs. In other words, drugs you fill at the pharmacy. Check your plan’s list of covered drugs to find out whether it covers the drugs you need. This list is called the formulary.

There are several drugs that may be covered by Part B or Part D. It depends on what you use the drug for and how it’s administered. Some of these drugs include:

 

Injectable drugs

• Part B covers injectable drugs if you usually cannot administer the drug yourself and your doctor provides the drug and administers it to you.
• Part D covers injectable drugs that you buy at the pharmacy, whether a doctor administers the drug or you administer it yourself.

 

Vaccines

• Part B covers certain vaccines. For example, influenza (flu) shots, pneumonia shots, and hepatitis B shots for certain people. Part B also covers vaccines after you have been exposed to a dangerous virus or disease, like tetanus.
• Part D covers most vaccines that your doctor recommends.

 

Insulin

• Part B may cover insulin that you use with an insulin pump. Insulin pumps, related supplies, and the insulin used with these pumps are covered as durable medical equipment (DME) if you meet Medicare’s coverage criteria.
• Part D covers insulin and related medical supplies if you self-inject insulin. Supplies include syringes, gauze, and alcohol swabs.

 

Immunosuppressants

• Part B covers your immunosuppressants if you had a kidney transplant in a Medicare-approved facility and you had Medicare Part A at the time of your transplant.
• Part D covers immunosuppressants if you did not have Medicare Part A at the time of your transplant or you did not have your transplant in a Medicare-approved facility.

 

Know how Medicare covers your medication.

• If you aren’t sure, call 1-800-MEDICARE (633-4227).
• If it’s a Part D drug, check that it’s on your plan’s list of covered drugs and see if there are any coverage restrictions.

 

If you have trouble accessing your Medications:

Ask your pharmacist or provider to submit claims to the correct part of Medicare.

• It’s possible that they are billing the medication incorrectly.
• If your provider is unsure of how to submit these claims, tell them they can reach out to your plan or to Medicare for help.

Make sure your pharmacist or provider has the documentation they need.

• For example, if your insulin should be covered by Part B because you use an infusion pump to take it, Medicare may need proof that you have an insulin pump

Appeal any denials.

• You have the right to appeal Medicare’s or your plan’s denial.
• Ask your doctor to help prove that your medication is medically necessary and that you meet the coverage criteria.
• If you need help appealing a denial, contact your Agent, SHIP or Medicare.

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FOR OTHER QUESTIONS, CONTACT AMERICAN SENIOR RESOURCES at 1-866-448-0160 TTY 711 M-F or SCHEDULE AN CONSULTATION ONLINE WITH AN ASR LICENSED AGENT.