Prescription Drugs Billed Under Part B Or Part D - Know The Difference In Advance!


Depending on how doctors bill prescription drugs administered in their offices, including expensive shots, the difference could cost you! If billed under Part D (Prescription Drugs) you would normally just pay your Part D Tier level copay of that drug (plus possibly a one time annual deductible depending on your plan.) However if billed under Part B, again depending on your specific plan, you may be responsible for 20% of the cost! So I highly suggest you contact your doctor and/or insurance company in advance beforehand, so you don’t get an unpleasant surprise in the way of a large bill afterwards without your knowledge.


It can be confusing, since some drugs may be listed under both Part B and Part D.

Part B can includeSelect prescription drugs, including immunosuppressant drugs, some anti-cancer drugs, some anti-emetic drugs, some dialysis drugs, and drugs that are typically administered by a physician.

Part D covers most outpatient prescription drugs (drugs you fill at a pharmacy).
Check your plan’s formulary to find out whether it covers the drugs you need.


Note:
Injectable osteoporosis drugs: Medicare helps pay for an injectable drug if you’re a woman with osteoporosis who meets the criteria for the Medicare home health benefit and has a bone fracture that a doctor certifies was related to post-menopausal osteoporosis. 
A doctor must certify that you can’t give yourself the injection or learn how to give yourself the drug by injection. The home health nurse or aide won’t be covered to provide the injection unless family and/or caregivers are unable or unwilling to give you the drug by injection.


Some additional resource website links are pasted below for more information:

https://www.medicare.gov/what-medicare-covers/what-part-b-covers

https://www.medicare.gov/coverage/prescription-drugs-outpatient

PDF Document downloaded by the web link below:

https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovcontra/downloads/partsbdcoveragesummarytable_041806.pdf



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