Chemotherapy drugs, Medicare

Applies to:

Priority Health Medicare plans


Chemotherapy drugs are used to treat cancer. 

Our Medicare Advantage plans cover chemotherapy drugs obtained in a provider's office or facility whether the provider participates in the patient's plan or not.

  • The member's cost share is 20% coinsurance.
  • In-network providers: Some plans have in-network deductibles.
  • Out-of-network providers: Out-of-network deductible applies. Members should use a Medicare-participating provider to receive the best benefit at this level.

Chemotherapy drug authorizations

Some drugs require prior authorization. You can find authorization forms and further information here:

Chemotherapy drug billing under Medicare

Direct billing

Providers may collect the 20% coinsurance at time of service or bill the member for it (Medicare Claims Processing Manual, Chapter 1, €30.3.1).

Providers may not bill for or try to collect any additional part of the bill from the member until the provider receives the Priority Health Medicare Remittance Advice (Medicare Claims Processing Manual, Chapter 1, €30.3.3).

Learn more

Get more details about billing chemotherapy drugs from: