Is This Prescription Part B or Part D? Sorting Out One of the Drug Benefit's Most Complicated Issues.

Summary

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Analysis and usage of drugs

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Is This Prescription Part B or Part D? Sorting Out One of the Drug Benefit's Most Complicated Issues.

Determining whether a drug is covered by Medicare Part B or Part D is one of the most complicated issues that has arisen with the implementation of the new outpatient prescription drug benefit. Medicare Part D coverage is excluded for drugs where coverage is available under Medicare Part B. In most cases a drug will be covered under Part D because it is dispensed in the retail setting as an outpatient prescription drug. However, in some cases, it is possible that a drug may be covered under Part B or D, and making such determinations is not always intuitive. Part of the reason for the confusing standards is the fact that drug coverage under Medicare Part B was implemented in a patchwork fashion to address specifically identified patient needs at a time when ther...

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