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.
