When it comes to drug coverage under Medicare, many people think of pharmacy prescriptions.
However, Medicare covers medications under two different parts: Part B drugs and Part D drugs. As confusion can be a bitter pill to swallow, read on and learn the difference!
Medicare Part B drugs are typically administered by a healthcare professional in a medical setting, such as in a doctor’s office, a clinic, or a hospital outpatient department. Examples include chemotherapy drugs, certain injectable medications for conditions like osteoporosis or rheumatoid arthritis, and infusion treatments.
Because they are administered in a clinical setting, Part B drugs are usually billed through medical insurance, not the pharmacy. Under Medicare Part B, you will typically pay 20 percent of the Medicare-approved amount (after your deductible is met) unless you have supplemental coverage like a Medigap plan.
In contrast, Part D drugs are the medicines most people think of when they hear “prescription drugs.” These are medications you pick up at a pharmacy and take yourself.
Coverage for these drugs comes through a separate prescription drug plan under Medicare Part D, or through a Medicare Advantage plan that includes drug coverage.
Part D plans use formularies, which are lists of covered medications organized into different cost tiers. Your out-of-pocket costs can vary depending on the drug tier, pharmacy network, and stage of coverage.
Another key difference is how these meds are approved. Part D drugs often require prior authorization, step therapy, or have quantity limits. Part B drugs may also require authorization, but the approval process usually happens through your provider’s office.
Depending on the type of Medicare plan you have, never hesitate to contact your insurance company or Medicare to determine your out-of-pocket costs for your medicines, as this knowledge will surely help to avoid any potential nasty surprises!
