Prescription drugs (outpatient)

Medicare Part B (Medical Insurance)  covers a limited number of outpatient prescription drugs under certain conditions.

Usually, Part B covers drugs you wouldn't typically give to yourself, like those you get at a doctor's office or in a hospital outpatient setting .

Here are some examples of Part B-covered drugs:

• New Alzheimer’s drug (Leqembi, generic name lecanemab): Medicare covers a new type of medication to slow or delay symptoms of Alzheimer’s. Talk to your provider about whether this drug is right for you.
  • This drug doesn’t cure or reverse Alzheimer’s disease.
  • The drug is given intravenously (through a vein) in a provider’s office or other outpatient setting.
  • If you and your provider decide this treatment is right for you, your provider will submit data as part of an effort to understand how well this new medication works as part of your care. This is part of the process so Medicare will cover the drug. 
• Drugs used with an item of durable medical equipment (DME): Medicare covers drugs infused through DME (like an infusion pump or nebulizer) if the drug used with the pump is reasonable and necessary.
• Some antigens: Medicare covers antigens if a doctor or other health care provider prepares them and a properly instructed person (who could be you, the patient) gives them under appropriate supervision.
• Injectable osteoporosis drugs.
• Erythropoiesis-stimulating agents: Medicare covers erythropoietin by injection if you have  End-Stage Renal Disease (ESRD)  or you need this drug to treat anemia related to certain other conditions.
• Blood clotting factors: If you have hemophilia, Medicare covers injectable clotting factors you give yourself.
• Injectable and infused drugs: Medicare covers most injectable and infused drugs when a licensed medical provider gives them.
• Oral End-Stage Renal Disease (ESRD) drugs: Medicare covers some oral ESRD drugs if the same drug comes in an injectable form and the Part B ESRD benefit covers it.

• Parenteral and enteral nutrition (intravenous and tube feeding): Medicare covers certain nutrients if you can’t absorb nutrition through your intestinal tract or take food by mouth.

• Intravenous Immune Globulin (IVIG): Medicare covers IVIG you get at home if both of these conditions apply:

  • You've been diagnosed with primary immune deficiency disease.
  • Your health care provider decides that it's medically appropriate for you.

  Part B also pays for other items and services related to you getting the IVIG at home.

• Shots (vaccinations): Medicare covers flu shots, pneumococcal shots and COVID-19 vaccines. Medicare also covers Hepatitis B shots for certain people, and some other vaccines when they’re related directly to the treatment of an injury or illness.

• Transplant / immunosuppressive drugs. Medicare covers transplant drug therapy if Medicare helped pay for your organ transplant. You must have Part A at the time of the covered transplant, and you must have Part B at the time you get immunosuppressive drugs. 

  If you only have Medicare because of End-Stage Renal Disease (ESRD), your Medicare coverage (including immunosuppressive drug coverage) ends 36 months after a successful kidney transplant. Medicare offers a benefit that helps you pay for your immunosuppressive drugs beyond 36 months if you don’t have certain types of other health coverage (like a group health plan, TRICARE, or Medicaid that covers immunosuppressive drugs). This benefit only covers your immunosuppressive drugs and no other items or services. It isn’t a substitute for full health coverage. If you qualify, you can sign up for this benefit any time after your Part A coverage ends. To sign up, call Social Security at 1-877-465-0355. TTY users can call 1-800-325-0788.
• Oral cancer drugs: Medicare covers some cancer drugs you take by mouth if the same drug is available in injectable form, or it's a prodrug of the injectable drug. A prodrug is an oral form of a drug that, when ingested, breaks down into the same active ingredient found in the injectable drug. 
• Oral anti-nausea drugs: Medicare covers oral anti-nausea drugs you get as part of an anti-cancer chemotherapeutic regimen if you take them before, during, or within 48 hours of chemotherapy, or you get them as full therapeutic replacement for an intravenous anti-nausea drug.
• Self-administered drugs in hospital outpatient settings: Under very limited circumstances, Medicare may pay for some self-administered drugs if you need them for the hospital outpatient services you're getting.