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:

• Drugs used with an item of durable medical equipment (DME): Medicare covers drugs infused through DME, like an infusion pump or drugs given by a nebulizer, if the drug used with the pump is reasonable and necessary.
• Some antigens: Medicare covers antigens if a doctor prepares them and a properly instructed person (who could be you, the patient) gives them under appropriate supervision.
• Injectable osteoporosis drugs: Medicare covers injectable osteoporosis drugs if you meet all of these conditions:

  • You're a woman with osteoporosis who meets the criteria for the Medicare home health benefit.

  • You have a bone fracture that a doctor certifies was related to post-menopausal osteoporosis.

  • Your doctor certifies that you can’t give yourself the injection or learn how to give yourself the drug by injection.

In addition, Medicare will cover the home health nurse or aide to provide the injection if your family and/or caregivers are unable or unwilling to give you the drug by injection.

• 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: Medicare covers clotting factors you give yourself by injection, if you have hemophilia.
• Injectable and infused drugs: Medicare covers most injectable and infused drugs when a licensed medical provider gives them, because these types of drugs aren't usually self-administered.
• Oral End-Stage Renal Disease (ESRD) drugs: Medicare covers some oral ESRD drugs if the same drug is available in 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) provided in home: Medicare covers IVIG if both of these conditions apply:
  • You have a diagnosis of primary immune deficiency disease.
  • Your doctor decides that it's medically appropriate for you to get the IVIG in your home.

Part B covers the IVIG itself, but doesn't pay for other items and services related to you getting the IVIG at home.

• Shots (vaccinations): Medicare covers flu shots, pneumococcal shots, COVID-19 vaccines, 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 paid 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. Keep in mind, Medicare drug coverage (Part D) covers immunosuppressive drugs if Part B doesn't cover them. If you have Original Medicare, you may join a Medicare drug plan to get Medicare drug coverage. 
  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 may help you, if you lose Part A coverage 36 months after a kidney transplant, and 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 oral cancer drugs you take by mouth if the same drug is available in injectable form or the drug is 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. As new oral cancer drugs become available, Part B may cover them. If Part B doesn’t cover them, Part D does.

• Oral anti-nausea drugs: Medicare covers oral anti-nausea drugs you use as part of an anti-cancer chemotherapeutic regimen if they’re administered before, at, or within 48 hours of chemotherapy or are used as a 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.