Medicare Part B vs Part D drug coverage

Your Medicare medical coverage works differently from your prescription coverage, but sometimes a drug falls under your medical coverage. If your doctor or other health care provider prescribes one of the drugs below for you, he or she may need to describe the use and setting of the drug so Priority Health knows if your Medicare Part B (medical) or Part D (prescription) coverage applies.

The prescription drugs listed below have a Part B versus Part D administrative prior authorization requirement. These drugs may be covered under Medicare Part B or Part D depending upon the circumstances. Information may need to be submitted describing the use and setting of the drug to make the determination.

• Priority Health authorizes and pays for the drugs listed below differently under different circumstances.
• These drugs usually carry the notation "B/D" in our Medicare formulary.

Click any link below to jump down to that section of this alphabetical list of B/D drugs.

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

AB

• Acyclovir Sodium INJ 500MG
• Albuterol Sulfate INHALATION NEBU
• Aminosyn INJ: 50.3MEQ/L; 695MG/100ML; 713MG/100ML; 490MG/100ML; 517MG/100ML; 350MG/100ML; 210MG/100ML; 462MG/100ML; 700MG/100ML; 735MG/100ML; 120MG/100ML; 209MG/100ML; 505MG/100ML; 371MG/100ML; 31.3MEQ/L; 280MG/100ML; 140MG/100ML; 189MG/100ML; 350MG/100ML, 86MEQ/L; 640MG/100ML; 490MG/100ML; 640MG/100ML; 150MG/100ML; 360MG/100ML; 470MG/100ML; 360MG/100ML; 200MG/100ML; 220MG/100ML; 5.4MEQ/L; 430MG/100ML; 210MG/100ML; 260MG/100ML; 80MG/100ML; 44MG/100ML; 400MG/100ML, 90MEQ/L; 1100MG/100ML; 850MG/100ML; 35MEQ/L; 1100MG/100ML; 260MG/100ML; 620MG/100ML; 810MG/100ML; 624MG/100ML; 340MG/100ML; 380MG/100ML; 5.4MEQ/L; 750MG/100ML; 370MG/100ML; 460MG/100ML; 150MG/100ML; 44MG/100ML; 680MG/100ML
• Aminosyn 7%/electrolytes
• Aminosyn II INJ 107.6MEQ/L; 1490MG/100ML; 1527MG/100ML; 1050MG/100ML; 1107MG/100ML; 750MG/100ML; 450MG/100ML; 990MG/100ML; 1500MG/100ML; 1575MG/100ML; 258MG/100ML; 447MG/100ML; 1083MG/100ML; 795MG/100ML; 62.7MEQ/L; 600MG/100ML; 300MG/100ML; 405MG/100ML; 750MG/100ML, 61.1MEQ/L; 844MG/100ML; 865MG/100ML; 595MG/100ML; 627MG/100ML; 425MG/100ML; 255MG/100ML; 561MG/100ML; 850MG/100ML; 893MG/100ML; 146MG/100ML; 253MG/100ML; 614MG/100ML; 450MG/100ML; 33.3MEQ/L; 340MG/100ML; 170MG/100ML; 230MG/100ML; 425MG/100ML
• Aminosyn II 3.5%/dextrose 5%
• Aminosyn II 4.25/dextrose 10%
• Aminosyn II 4.25/dextrose 20% INJ 30.6MEQ/L; 422MG/100ML; 432MG/100ML; 298MG/100ML; 20%; 258MG/100ML; 212MG/100ML; 128MG/100ML; 280MG/100ML; 425MG/100ML; 446MG/100ML; 73MG/100ML; 126MG/100ML; 307MG/100ML; 225MG/100ML; 19MEQ/L; 170MG/100ML; 85MG/100ML; 115MG/100ML; 212MG/100ML
• Aminosyn II 8.5%/electrolytes
• Aminosyn-hf
• Aminosyn-pf
• Aminosyn-pf 7%
• Anzemet ORAL TABS
• Aranesp Albumin Free INJ 100MCG/0.5ML, 100MCG/ML, 150MCG/0.3ML, 200MCG/0.4ML, 200MCG/ML, 25MCG/0.42ML, 25MCG/ML, 300MCG/0.6ML, 300MCG/ML, 40MCG/0.4ML, 40MCG/ML, 500MCG/ML, 60MCG/0.3ML, 60MCG/ML
• Azasan
• Azathioprine
• Azathioprine Sodium
• Azithromycin INJ 500MG
• Boniva INJ
• Brovana
• Budesonide INHALATION SUSP
• Butorphanol Tartrate INJ

back to top

C

• Calcitriol
• Cellcept SUSR
• Cinryze
• Clindamycin Phosphate Add-vantage
• Clinimix 2.75%/dextrose 5%
• Clinimix 4.25%/dextrose 10%
• Clinimix 4.25%/dextrose 20%
• Clinimix 4.25%/dextrose 25%
• Clinimix 4.25%/dextrose 5%
• Clinimix 5%/dextrose 15%
• Clinimix 5%/dextrose 20%
• Clinimix 5%/dextrose 25%
• Clinimix E 2.75%/dextrose 10%
• Clinimix E 2.75%/dextrose 5%
• Clinimix E 4.25%/dextrose 25%
• Clinimix E 4.25%/dextrose 5%
• Clinimix E 5%/dextrose 15%
• Clinimix E 5%/dextrose 20%
• Clinimix E 5%/dextrose 25%
• Cromolyn Sodium NEBU
• Cubicin
• Cyclophosphamide
• Cyclosporine INJ
• Cyclosporine ORAL CAPS
• Cyclosporine Modified

back to top

D

• Dextrose 10% Flex Container
• Dextrose 10%/nacl 0.2%
• Dextrose 10%/nacl 0.45%
• Dextrose 2.5%/nacl 0.45%
• Dextrose 2.5%/sodium Chloride 0.45%
• Dextrose 5%
• Dextrose 5%/electrolyte #48 Viaflex
• Dextrose 5%/lactated ringers
• Dextrose 5%/nacl 0.2%
• Dextrose 5%/nacl 0.225%
• Dextrose 5%/nacl 0.33%
• Dextrose 5%/nacl 0.45%
• Dextrose 5%/nacl 0.9%
• Dextrose 5%/sodium Chloride 0.2%
• Dextrose 5%/sodium Chloride 0.33%
• Dextrose 5%/sodium Chloride 0.9%
• Dronabinol

back to top

EF

• Elaprase
• Emend ORAL CAPS
• Epogen
• Freamine III INJ 72MEQ/L; 600MG/100ML; 810MG/100ML; 3MEQ/L; 14MG/100ML; 1190MG/100ML; 240MG/100ML; 590MG/100ML; 770MG/100ML; 620MG/100ML; 450MG/100ML; 480MG/100ML; 10MMOLE/L; 115MG/100ML; 950MG/100ML; 500MG/100ML; 10MEQ/L; 340MG/100ML; 130MG/100ML; 560MG/100ML

back to top

GH

• Gengraf
• Granisetron Hcl TABS
• Granisol
• Havrix
• Hectorol
• Heparin Sodium

back to top

IJK

• Ifex INJ 3GM
• Imovax Rabies (h.d.c.v.)
• Intralipid
• Ipratropium Bromide INHALATION SOLN 0.02%
• Ipratropium Bromide/albuterol sulfate
• Kalbitor
• Kcl 0.15%/d5w/ Nacl 0.3%
• Kcl 0.15%/d5w/lr
• Kcl 0.15%/d5w/nacl 0.45%
• Kcl 0.224%/d5w/nacl 0.2%
• Kcl 0.3%/d5w/lr IV Lac Ring
• Krystexxa

back to top

LM

• Lactated Ringers
• Lactated Ringers Viaflex
• Leucovorin Calcium INJ
• Levalbuterol
• Levocarnitine
• Lidocaine OINT
• Lidocaine Hcl GEL
• Lidocaine Hcl Jelly
• Lidocaine/prilocaine
• Lupron Depot
• Lupron Depot-ped INJ 11.25MG, 15MG, 7.5MG
• Magnesium Sulfate INJ
• Magnesium Sulfate In D5w INJ 5%; 10MG/ML
• Makena
• Metoclopramide Hcl INJ
• Miacalcin INJ
• Mycophenolate Mofetil
• Myfortic

back to top

NO

• Nephramine
• Neutrexin
• Normosol -r
• Normosol-m in D5w
• Ondansetron Hcl ORAL SOLN
• Ondansetron Hcl ORAL TABS
• Ondansetron Odt

back to top

PQ

• Pamidronate Disodium INJ 30MG/10ML, 6MG/ML, 90MG/10ML
• Perforomist
• Photofrin
• Potassium Chloride INJ 10MEQ/100ML, 2MEQ/ML, 30MEQ/100ML
• Potassium Chloride 0.075%/d5w/nacl 0.225%
• Potassium Chloride 0.15% /nacl 0.45% Viaflex
• Potassium Chloride 0.15%/d5w
• Potassium Chloride 0.224%/d5w
• Potassium Chloride 0.3%/ Nacl 0.9%
• Potassium Chloride 0.3%/d5w
• Potassium Chloride 0.3%/nacl 0.9%/viaflex
• Premasol
• Procalamine
• Procrit
• Pulmicort SUSP 1MG/2ML
• Pulmozyme

back to top

RS

• Rabavert
• Rapamune
• Reclast
• Recombivax Hb INJ 10MCG/ML, 40MCG/ML
• Rheumatrex
• Sodium Chloride 0.45% Viaflex
• Somatuline Depot
• Synera

back to top

TU

• Tacrolimus
• Teflaro
• Tobi
• Trexall
• Trophamine

back to top

VWXYZ

• Vancomycin Hcl INJ 1000MG, 10GM, 5000MG, 500MG
• Vaqta INJ 25UNIT/0.5ML
• Vibativ
• Virazole
• Xopenex
• Zemplar
• Zometa INJ 4MG/5ML
• Zortress
• Zuplenz

back to top