If you’re wondering how Medicare covers medications, we have some answers for you!  There is a broad range of viable plans to cover your medication needs. Of course, Part D includes most of your outpatient prescription drugs. Today we’re looking specifically at how Part B helps those with extensive medical needs to get adequate coverage for medications and equipment. The following guide outlines what you need to know.

Which Medications Are Covered Under Part B?

Medicare Part B covers medications that can’t be accessed on your own. Usually, this means they’re considered outpatient medications that need to be provided by a facility or hospital.  Part B medications usually require a 20% co-insurance.

They might also be medications that a doctor would determine you’re unable to provide yourself. Common examples include intravenous or feeding tubes, injectable and infused drugs, erythropoiesis-stimulating agents, vaccinations, and transplant/immunosuppressive medications. 

What Is Step Therapy & How Does It Impact Coverage?

In some cases, Part B drugs may be subject to Step Therapy like Part D drugs are.  This is a situation where the health/prescription drug plan requires you to use a generic or plan-preferred substitute first to assess if it is sufficient for your need. This is known as Step Therapy, and it helps limit exorbitant insurance costs. However, if you have concerns about the substitution requested, there are other options available. 

The law protects your right to request what is known as an “exception”. You can file an exception request to your plan with your physician’s assistance. If you’re under a particularly tight deadline to get an answer, you can even request an expedited process to gain access to your medication sooner.

If you need help obtaining coverage for your health care needs, turn to The Clemente Agency in Gilbert, AZ. This reputable agency works with major insurance carriers to provide people with the options they deserve. The insurance broker, Sharon Clemente, has over 14 years of experience and will fill the gaps in your coverage. Visit the website or call (480) 209-2250 to schedule a consultation today.