Medicare Corner
Part B vs. Part D Drugs Most drugs covered by Medicare are covered by Part D. But in some cases, Part B or Part A pays for drugs. Knowing these rules can help you get your prescriptions with fewer problems. Here are some of Medicare’s rules for covering prescription drugs: Know when Parts A, B, and D cover prescription drugs. • Part A covers the drugs you need during a Medicare-covered stay in a hospital or skilled nursing facility. • Part B covers drugs administered by your provider or at a dialysis facility where the provider or facility supplies and administers the drugs. Part B also covers some outpatient prescription drugs, mainly some oral cancer drugs used in chemo- therapy. Part D cannot pay for any drugs that Part B covers.
• Vaccines: Part D covers most vaccines your doctor recommends. Part B covers some vaccines, though. For example, flu shots, pneumonia shots, COVID-19 shots, and hepatitis B shots for certain people are covered. Part B also covers vaccines after you’ve been exposed to a dangerous virus or disease, such as tetanus. • Insulin: If you self-inject insulin, Part D covers insulin and related medical supplies. For example, syringes, gauze, and alcohol swabs are covered. Part B covers insulin that you use with a Part B-covered insulin pump. Part B covers insulin pumps, related supplies, and the insulin used with these pumps as durable medical equipment. • Immunosuppressants: Part B covers your immunosuppressants if you had a kidney transplant in a Medicare-approved facility, and you had Medicare Part A at the time of your transplant. Part D covers immunosuppressants if you didn’t have Part A at the time of your transplant, or you didn’t have your transplant in a Medicare-approved facility. • HIV Prevention and Treatment: Part B covers both oral and injectable PREP to prevent HIV if you are at an increased risk. Also, Part B covers individual counseling and HIV screenings. Part D covers PrEP if you currently have HIV and use PrEP to treat HIV. For Medicare Advantage coverage check with your plan provider.
• Part D covers most outpatient prescription drugs you get at the pharmacy. Check your plan’s list, called a “formulary,” of covered drugs to find out if it covers your drugs. Understand when Part B or Part D can cover certain drugs. Some drugs may be covered by Part B or Part D. The part that covers your drug depends on what the drug is used for and how you take it. For example: • Injectable drugs: Part B covers injectable drugs if you can’t inject the drug yourself and your doctor provides the drug in their office and injects the drug for you. Part D covers injectable drugs that you buy at the pharmacy and take yourself. Part D also covers injectable drugs that you buy at the pharmacy and bring to your doctor’s office for them to inject for you.
Page 6 | July & August 2025, Never Too Late
Pima Council on Aging
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