Medicare Part B Drugs
Under certain conditions, Medicare Part B covers outpatient prescription drugs and biologicals. For example, Part B might cover drugs provided as part of a physician's service or furnished for use with covered durable medical equipment. Many Medicare Part B drugs are administered by infusion or injection in physician offices, hospital outpatient departments or other clinical settings under the supervision of healthcare professionals. Generally, Part B covers only drugs that are not usually self-administered.
Medicare Part B Step Therapy
Applies to members new to therapy
In some cases, we require you to try certain drugs first to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A doesn't work for you, we'll then cover Drug B. The list of preferred products should be used first.
Medicare Part B Prior Authorization
Certain medical drugs require prior authorization to ensure safe and effective use. The prior authorization criteria are consistent with Medicare requirements defined in CMS National Coverage Determinations (NCDs) and relevant Local Coverage Determinations (LCDs).
Medicare Part B Drug Update
From time to time, adjustments are made to our prior authorization list—the list of drugs that require authorization from you doctor before they're prescribed. This update provides information on recent changes.
Medicare Part B Medical Policies
Our medical policy and drug guidelines.