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:

• Monoclonal antibodies for the treatment of early Alzheimer’s Disease
• Drugs used with an item of durable medical equipment (DME): Medicare covers drugs infused through DME (like an infusion pump or nebulizer) if the drug used with the pump is reasonable and necessary.
• Some antigens: Medicare covers antigens if a doctor or other health care provider prepares them and a properly instructed person (who could be you, the patient) gives them under appropriate supervision.
• HIV prevention drugs.
• Injectable osteoporosis drugs.
• 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: If you have hemophilia, Medicare covers injectable clotting factors you give yourself.
• Injectable and infused drugs: Medicare covers most injectable and infused drugs when a licensed medical provider gives them.
• Oral End-Stage Renal Disease (ESRD) drugs: Medicare covers some oral ESRD drugs if the same drug comes in an 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): Medicare covers IVIG you get at home if both of these conditions apply:

  • You've been diagnosed with primary immune deficiency disease.
  • Your health care provider decides that it's medically appropriate for you.

  Part B also pays for other items and services related to you getting the IVIG at home.

• Shots (vaccinations): Medicare covers flu shots, pneumococcal shots and COVID-19 vaccines. Medicare also covers 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 helped pay 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. 

  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 helps you pay for your immunosuppressive drugs beyond 36 months if 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 cancer drugs you take by mouth if the same drug is available in injectable form, or it's 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. 
• Oral anti-nausea drugs: Medicare covers oral anti-nausea drugs you get as part of an anti-cancer chemotherapeutic regimen if you take them before, during, or within 48 hours of chemotherapy, or you get them as 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.