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Drug Coverage and Costs

Medicare prescription drug coverage, also known as Part D, covers some of the drugs you will need to take to treat cancer. You need to join a Medicare drug plan to get your drugs covered. Learn how to join a plan.

If you have cancer, Medicare Part B will pay for many of your drugs. This is especially the case with drugs that fight your cancer, or chemotherapy drugs. Medicare Part B also covers doctor visits, outpatient hospital care, and other services. Learn what services Medicare covers under Part B.

It can be hard to understand why Medicare covers some drugs under Part D and others under Part B. But it is important to know the difference. How you get your drugs and what you pay will differ if Medicare Part B or Part D covers your drugs.

Which drugs does Medicare Part B cover?

Medicare Part B covers most of the drugs to treat your cancer that are given as a shot, through an IV tube, or by mouth. These are called chemotherapy drugs. Your doctor or treatment center gets the drugs. Then your doctor or a nurse puts them in your veins or gives you a pill or liquid to swallow.

Many chemotherapy drugs can cause nausea and vomiting. You will get anti-nausea drugs when you get your chemotherapy.

Which oral cancer drugs does Part B cover?

Medicare Part B covers cancer drugs that you have put in your veins or can take by mouth. If your drug is only made to be taken by mouth, your Medicare Part D plan should cover it.

How does Medicare cover anti-nausea drugs?

It covers them the same way Medicare covers cancer drugs. If you can take your anti-nausea drug by mouth or in your veins, then Medicare Part B will cover either one. But your doctor must give it to you within 48 hours of your cancer treatment. Otherwise, your Medicare Part D plan should cover it.

Which drugs does a Medicare Part D drug plan cover?

Generally, your Medicare Part D drug plan will cover these drugs:

  • Drugs that are prescribed for you but are not taken as part of chemotherapy to treat your cancer
  • Drugs that you take on your own without help from a doctor or nurse
  • Anti-nausea drugs you can only take by mouth

What will drugs cost under Medicare Part B?

Medicare pays for most of the costs of drugs given in a doctor's office or treatment center.

Note: You will pay 20% of the cost of your drugs. There is no limit to the total amount you pay. This is why many people with Medicare have Medicare supplemental insurance, called Medigap, or other insurance coverage such as through the Veterans Administration (VA) or Medicaid. The extra insurance helps pay for the costs Medicare Part B does not cover.

What will drugs cost under Medicare Part D?

That will depend on your Medicare Part D drug plan. Your costs can vary by plan and by drug. Learn more about Part D costs.

Can I get help with my drug costs?

If your income and savings are limited, you may qualify for help paying for the cost of your prescription drugs. Some programs that offer help with paying for drug costs are:

  • Low-Income Subsidy (LIS), also called Extra Help. Social Security and Medicare work together to help people with limited income and resources pay for their Part D costs. The program pays for your Part D premiums, deductible, and copayments. Learn more about Extra Help.
  • State Pharmacy Assistance Programs. Some states have a State Pharmaceutical Assistance Program that can help you with your drug costs.
  • Patient Assistance Programs. Some drug companies give free or low-cost drugs to people who have Medicare Part D drug plans. This help does not count toward your Part D out-of-pocket drug costs. But if you have to pay a small fee for these drugs, the fee does count.

Get personal help to learn more about any of these programs, or other programs that can assist with the costs of prescription drugs.

If a cancer drug is being used off-label, will Medicare cover it?

The U.S. Food and Drug Administration, or FDA, approves each new drug before it goes on the market. Each drug is approved based on how safe it is and how well it works to treat a specific condition.

After the FDA approves a drug, doctors may prescribe it. But doctors may give you a drug for a different use than the drug was meant for initially. This is called off-label use. It happens a lot, especially in treating cancer. Medicare may cover drugs prescribed for off-label use in cancer care. But Medicare has specific rules about when it will do so.

Medicare Part B covers most cancer care and chemotherapy. It also will cover these drugs if the off-label use has been described in special publications for cancer specialists.  Your doctor or treatment center can tell you if your drug has been.

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