Jeffrey Wade
Medicare Part B (Medical Insurance) covers a limited number of outpatient prescription drugs under certain conditions. Doctors, other healthcare providers, and pharmacies must accept assignment for Part B-covered drugs, so they should never ask for more than the copayment or coinsurance for the drug itself. In most cases, after meeting the Part B deductible, you pay up to 20% of the Medicare-approved amount for covered Part B prescription drugs. You can choose where to fill your prescriptions, but using certain types of pharmacies might save you money. Some pharmacies may offer a 2- or 3-month supply of covered drugs. Medicare plans have contracts with in-network pharmacies that offer discounted prices for members. In some plans, drugs are only covered if they are filled at in-network pharmacies.
| Characteristics | Values |
|---|---|
| Medicare Drug Coverage | Optional and offered by insurance companies and private companies approved by Medicare |
| Medicare Part B | Covers a limited number of outpatient prescription drugs under certain conditions |
| Pharmacies | In-network pharmacies offer discounted prices for members of certain Medicare plans |
| Out-of-network pharmacies | You will have to pay the full cost of the drugs |
| Preferred in-network pharmacies | May save you money on out-of-pocket drug costs |
| Mail-order pharmacy | A cost-effective and convenient way to get drugs you take regularly |
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What You'll Learn
Medicare Part B covers outpatient prescription drugs under certain conditions
Medicare Part B covers a limited number of outpatient prescription drugs under specific conditions. Typically, Part B covers medications that are not self-administered, such as those administered in a doctor's office or hospital outpatient setting.
Part B covers drugs used with certain types of durable medical equipment (DME) when medically necessary. This includes medications infused through DME, like an infusion pump or nebulizer. Additionally, Part B covers certain antigen allergy tests and treatments when prepared by a healthcare provider and administered under appropriate supervision.
Part B also covers HIV prevention drugs, injectable osteoporosis medications, and erythropoiesis-stimulating agents for individuals with End-Stage Renal Disease (ESRD) or those treating anemia related to certain other conditions. Oral cancer drugs are covered if the same drug is available in an injectable form or if it is a prodrug of the injectable version.
Medicare Part B also covers oral anti-nausea medications for cancer patients when taken before, during, or within 48 hours of chemotherapy. In rare cases, Part B may cover some self-administered drugs in hospital outpatient settings if they are necessary for the outpatient services being provided.
It is important to note that doctors, healthcare providers, and pharmacies must accept assignment for Part B-covered drugs. This means that they should not ask patients to pay more than the coinsurance or copayment for the covered drug. After meeting the Part B deductible, individuals usually pay up to 20% of the Medicare-approved amount for covered Part B prescription drugs.
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Medicare Part D is a separate drug plan
Medicare Part D prescription drug coverage is available through stand-alone plans or Medicare Advantage plans. In 2024, 57% of Medicare beneficiaries enrolled in Medicare Part D plans were enrolled in Medicare Advantage plans, while 43% were enrolled in stand-alone plans. The number of plan options varies across states and regions, with beneficiaries in each state having access to at least a dozen stand-alone plans.
Medicare Advantage plans with prescription drug coverage are becoming more popular, with more people in Medicare getting Part D drug coverage through these plans. However, the overall number of stand-alone plans is expected to decrease in 2025, with fewer plans available for enrollment of Part D Low-Income Subsidy beneficiaries.
Medicare Part D plans can help you save money on prescription drugs. Some plans offer discounts, and you can use your Medicare drug coverage at your local retail pharmacy. However, some plans may only cover your drugs if you get them filled at a pharmacy within their network. It is important to review the details of your specific plan to understand your coverage and any associated costs.
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In-network pharmacies offer discounted prices
Medicare Part B (Medical Insurance) covers a limited number of outpatient prescription drugs under certain conditions. Medicare drug coverage (Part D) is optional and offered to everyone with Medicare by insurance companies and other private companies approved by Medicare. Medicare plans have contracts with "in-network pharmacies" that offer discounted prices for members of certain Medicare plans. In some Medicare plans, your drugs are only covered if you get them filled at in-network pharmacies. If your plan has “preferred in-network pharmacies”, they may save you money on your out-of-pocket drug costs (like a copayment or coinsurance) because they have agreed to charge less than other pharmacies in your plan’s network.
Many plans may offer cost savings if you fill your prescriptions at a pharmacy within the plan's preferred network. You can use your mobile device to get instant access to see your prescriptions, find pharmacies, and more. You can download the UnitedHealthcare app to get instant access to see your prescriptions, find pharmacies, and more. You can also use the app to compare medication prices.
Doctors, other healthcare providers, and pharmacies must accept assignment for Part B-covered drugs, so they should never ask you to pay more than the coinsurance or copayment for the Part B-covered drug itself. You might pay a lower coinsurance for certain Part B-covered drugs and biologicals you get in a doctor's office, pharmacy, or outpatient setting if their prices have gone up faster than the rate of inflation.
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Out-of-network pharmacies may require full payment
Medicare Part B (Medical Insurance) covers a limited number of outpatient prescription drugs under certain conditions. Doctors, other healthcare providers, and pharmacies must accept assignment for Part B-covered drugs, so they should never ask you to pay more than the coinsurance or copayment for the Part B-covered drug itself. You might pay a lower coinsurance for certain Part B-covered drugs and biologicals you get in a doctor's office, pharmacy, or outpatient setting if their prices have gone up faster than the rate of inflation.
Medicare drug coverage (Part D) is optional and offered to everyone with Medicare by insurance companies and other private companies approved by Medicare. Some Medicare drug plans offer a discount or only cover your drugs when you get them filled at a pharmacy in their network. You can use your Medicare drug coverage at your local retail pharmacy.
There may be times when you can't use an in-network pharmacy. In such cases, you may be covered for prescriptions filled at an out-of-network pharmacy. This may include situations where there is no in-network pharmacy close to you that is open, or you need a drug that you can't get at a nearby in-network pharmacy, or you need a drug for emergency or urgent medical care, or you must leave your home due to a federal disaster or other public health emergency.
If you must use an out-of-network pharmacy, you may have to pay the full cost instead of a copay when you fill your prescription. You can then request reimbursement for the plan's share of the cost by submitting a prescription drug claim form along with your receipt. You may pay more for the drug because the out-of-network pharmacy's price is higher than what an in-network pharmacy would charge. Out-of-network claims will be covered for up to a 30-day supply for each claim.
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Doctors and pharmacies must accept Part B-covered drugs
Medicare Part B covers a limited number of outpatient prescription drugs under certain conditions. Doctors, other healthcare providers, and pharmacies must accept assignment for Part B-covered drugs. This means they should not ask you to pay more than the coinsurance or copayment for the Part B-covered drug itself. If you pay out-of-pocket for your drugs, you can save your receipts and contact your plan to get reimbursed.
Part B covers most drugs administered by your provider or at a dialysis facility, but the provider or facility must buy and supply the drugs. It also covers some outpatient prescription drugs, mainly certain oral cancer drugs (chemotherapy). Outpatient drugs previously paid for by Part B will continue to be paid for by Part B. Part B also covers certain drugs infused in the home. To be covered by Part B, the drug to be infused in the home must require administration using a Part B-covered infusion pump, and the administration of the drug in the home must be reasonable and necessary.
Part B covers most injectable and infused drugs when administered by a licensed medical provider. For example, oncologists, rheumatologists, and urologists. Generally, Part B covers only drugs that are not usually self-administered. However, under very limited circumstances, Medicare may pay for some self-administered drugs if you need them for hospital outpatient services.
Medicare Part D, also known as the Medicare prescription drug benefit, is offered by private companies approved by Medicare. It covers your prescription drugs in most cases. You can use your Medicare drug coverage at your local retail pharmacy. Some Medicare drug plans offer a discount or only cover your drugs when you get them filled at a pharmacy in their network.
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Frequently asked questions
Medicare Part B is Medical Insurance that covers a limited number of outpatient prescription drugs under certain conditions.
Part B covers drugs that are typically administered by a doctor or in a hospital setting, such as drugs used with durable medical equipment (DME) and certain antigen allergy tests and treatments.
You can fill your prescriptions at the pharmacy of your choice, but using "in-network pharmacies" can save you money. These pharmacies offer discounted prices for members of certain Medicare plans. Check with your plan to see if they have preferred in-network pharmacies, as these may offer additional cost savings.
If you use an out-of-network pharmacy, you may have to pay the full cost of the drugs upfront. However, you can keep your receipts and contact your plan to see if they will refund a portion of your costs.
Yes, some Medicare plans offer a mail-order program that allows you to receive a supply of your covered drugs directly to your home. This option may be more cost-effective and convenient for certain medications.
