BALTIMORE--Since the launch of the Part D Medicare drug benefit at the start of the New Year, there has been much confusion over which drugs should be billed under Part D and which under Part B. Callers from physician offices and pharmacies to DME companies, skilled nursing facilities and hospitals reportedly have jammed CMS’ phone lines with questions.
But in a conference call on Tuesday, CMS officials said the answer is fairly simple: If drugs were covered under Part B before Jan. 1, they should still be billed under Part B.
“If you were billing Part B in December for these drugs, they are still B drugs,” according to CMS Chief Medical Officer Jeffrey Kelman.
Further, explained Craig Miner, a pharmacist in CMS’ Division of Drug Plan Policy, a drug can only be covered under Part D if it is not covered under Part B.
Drugs administered through DME such as an infusion pump or nebulizer at a beneficiary’s home are still covered under Part B. But Part D may cover some drugs when the situation does not allow for coverage under Part B. For example, Part B covers albuterol solution for the home care setting but not for patients in long-term care. Also, Part B covers many drugs that are administered in a physician’s office, but some of the same drugs are not covered if patients buy them at a pharmacy to self-administer.
Part D enrollment is voluntary, with the benefit administered by private prescription drug plans and managed care plans, while CMS contractors under traditional fee-for-service Medicare administer Part B claims.
To view a chart with more information about which drugs are covered under Part B and Part D, a href=”www.cms.hhs.gov/Pharmacy/Downloads/partsbdcoverageissues.pdf”>click here.
