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Medicare Parts A, B and D drug coverage

When you have a Priority Health Medicare Advantage plan, your drugs are covered in one of three ways - under Part A (hospitalization), Part B (medical) or Part D (prescription) coverage. Here's some help figuring out how it all works.

Know what Parts A, B, and D pay for

You have Medicare Part A, hospitalization coverage, if you are enrolled in:

  • Original Medicare, or
  • A Medicare Advantage plan

When Medicare Part A pays for drugs

  • During Medicare-covered hospital stays
  • During Medicare-covered stays in skilled nursing facilities
  • For symptom control or pain relief when you're in hospice care

You have Medicare Part B doctor visit and medical coverage if you are enrolled in:

  • Original Medicare and you're paying your Part B premium, or
  • A Medicare Advantage plan

What Medicare Part B will pay for

  • COVID-19 vaccine. The approved COVID-19 vaccines, including boosters and administration when given consistent with their approved and recommended use.
  • Injections, supplies and some other drugs that your doctor gives you/you use during your visit. The doctor includes them on the bill for your appointment.
  • Durable medical equipment (DME) supply drugs. These are drugs you take using a piece of covered DME (e.g., a nebulizer, external or implantable pump).
  • Immunosuppressive drugs. Drugs used when you have received a Medicare-covered organ transplant.
  • Hemophilia clotting factors. For hemophilia patients who know how to use such factors to control bleeding without medical supervision, and items related to taking these factors.
  • Oral anti-cancer drugs. Drugs taken by mouth during cancer chemotherapy, if they have the same active ingredients and are used for the same reasons as chemotherapy drugs that Medicare covers when given by physicians.
  • Oral anti-emetic drugs. Oral anti-nausea drugs given within 48 hours of chemotherapy.
  • Pneumococcal vaccine. The pneumonia vaccine and its administration, if ordered by a physician.
  • Hepatitis B vaccine. The vaccine and its administration, for people at high or intermediate risk of contracting hepatitis B.
  • Influenza vaccine. The flu vaccine and its administration, when given in compliance with a state law. You may get the vaccine upon request without a physician's order and without physician supervision. 
  • Antigens. These are prepared by a physician (usually an allergist) for a specific patient. The physician or physician's nurse generally gives them in the physician's office. In some cases the physician prepares antigens and furnishes them to a patient who has been taught to self-administer them at home.
  • Erythropoietin (EPO). For treatment of anemia for people with chronic renal failure who are on dialysis.
  • Parenteral nutrition. Parenteral nutrients are covered under the prosthetic benefit. They are available to people who can't absorb nutrition through their intestines. Parenteral nutrition is administered intravenously and is regulated as a drug by the FDA.
  • Intravenous immune globulin (IVIG) provided in the home. For beneficiaries diagnosed with primary immune deficiency disease, if a physician determines that administering IVIG in the patient's home is medically appropriate. Payment is limited to that for the IVIG itself and does not cover items and services related to administration of the product.
  • Some diabetes supplies: Part B covers glucose monitors, test strips and lancets.

Original Medicare doesn't include prescription drug coverage. Neither do Medigap (Medicare Supplement insurance) plans. You have Medicare Part D prescription coverage if you are enrolled in:

  • A MAPD (Medicare Advantage + prescription drug) plan, or
  • A plan that only covers Medicare Part D

What Medicare Part D pays for

  • Prescription drugs that you get from a pharmacy, that you take on your own, that are on your plan’s Approved Drug List (formulary) or that are not on the formulary but for which an exception has been granted, and drugs that are not otherwise covered under Medicare Part A or Part B.
  • Some vaccines other than the ones mentioned under Part B. When vaccines are covered by Part D, they are listed in your plan's approved drug list (formulary).
  • Some diabetes supplies: Part D covers insulin syringes, needles, alcohol swabs and gauze for members taking insulin.
  • Self-administered drugs:  Part D usually covers self-administered drugs received in an outpatient setting. 

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