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Prescription Drugs Medicare Coverage Detailed

Your Medicare Coverage

Prescription Drugs Detailed

Coverage: Conditions that must be met before Medicare will provide coverage, and limits to coverage.

Medicare does not cover most prescription drugs. Medicare covers a limited number of outpatient prescription drugs. Your pharmacy or doctor must accept assignment on Medicare-covered prescription drugs.

The following outpatient prescription drugs are covered:

  • Some Antigens: Medicare will help pay for antigens if they are prepared by a doctor and administered by a properly instructed person (who could be the patient) under doctor supervision.
  • Osteoporosis Drugs: Medicare helps pay for an injectable drug for osteoporosis for certain women with Medicare. Please refer to the coverage information for Home Health Care.
  • Erythropoietin (Epoetin alpha or Epogen®): Medicare will help pay for erythropoietin by injection if you have end-stage renal disease (permanent kidney failure requiring either dialysis or transplantation) and need this drug to treat anemia.
  • Hemophilia Clotting Factors: If you have hemophilia, Medicare will help pay for your self-administered clotting factors.
  • Injectable Drugs: Medicare covers most injectable drugs administered by a licensed medical practitioner.
  • Immunosuppressive Drugs: Medicare covers immunosuppressive drug therapy for transplant patients if the transplant was paid for by Medicare, or paid by a private insurance that paid as a primary payer to your Medicare Part A coverage, in a Medicare-certified facility.
  • Oral Cancer Drugs: Medicare will help pay for some oral cancer drugs if the same drug is available in injectable form.

    Currently, Medicare covers the following oral cancer drugs:

    • Capecitabine (brand name Xeloda®)
    • Cyclophosphamide (brand name Cytoxan®)
    • Methhotrexate
    • Temozolomide (brand name Temodar®)
    • Busulfan (brand name Myleran®)
    • Etoposide (brand name VePesid®)
    • Melphalan (brand name Alkeran®)


    As new cancer drugs and brand names become available, additional oral cancer drugs may be added to the list of covered drugs.


  • Oral Anti-Nausea Drugs: Medicare will help pay for oral anti-nausea drugs if you are getting Medicare-covered oral cancer drugs.

Medicare also covers some drugs used in infusion pumps and nebulizers if considered reasonable and necessary.

CoPayment: The amount you need to pay.

You pay 100% for most prescription drugs.

You pay 20% of the Medicare-approved amount for covered prescription drugs.

Medicare Part: The part of Medicare that pays for this service or supply.

B

Organization Name: The organization name that this coverage topic is associated with.

Important Notes: Details regarding important notes about the coverage.

You must pay an annual $147 deductible for Part B services and supplies before Medicare begins to pay its share.