Part B Covered Drugs

Cynthia has COPD and uses inhalers which are very expensive and covered under her Part D prescription drug plan.  She was recently informed that breathing treatments with a nebulizer would help alleviate her breathing discomfort, provide less dependency on the inhalers allowing for a more extended use.  The drugs used in the machine are covered under Part B. In fact, there are many drugs which fall into that purview.

Beth, who had not elected to enroll in an independent drug plan as her pharmacist daughter was providing for her, found the cost of  late enrollment in a plan prohibitive when her daughter lost her job and could not provide the service. She was later diagnosed with cancer and quite relieved to discover the chemotherapy drugs were covered under Part B with no additional cost to her.

Generally Part B does not cover most prescription drugs used at home but there are a limited number of prescription drugs that are covered in limited circumstances. Some examples of drugs Part B covers:

• Drugs used with an item of durable medical equipment

• Some antigens

• Injectable osteoporosis drugs

• Erythropoiesis- stimulating agents: ESRD and anemia

• Blood clotting factors: hemophilia

• Oral ESRD drugs

• Parenteral and enteral nutrition

• Intravenous Immune Globulin (IVIG) provided in home

• Vaccinations: Flu, Pneumococcal, Hepatitis B

• Transplant drugs

• Some oral cancer drugs

• Oral anti-nausea drugs

Outside of the drugs covered by Part B, you are responsible for 100% of the cost of your drugs, unless you have Part D or other prescription drug plan and the prescriptions are listed on the formulary.  Drug plans are contractual and the premiums, deductible, copays, preferred pharmacies and formularies change every calendar year and should be reviewed to ascertain their viability for your needs during open enrollment (October 15 - December 7).  If you need help, please call 440-223-5437 or email calveyg@gmail.com.