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Medicare Drug Bills: Outpatient Prescriptions and Special Part B Coverage

Adapted from Your Medicare Benefits, Centers for Medicare & Medicaid Services. The selected guidance concerns Medicare coverage and payment, not a recommendation for medical treatment. Numbered page references below refer to the linked source publication.

Coverage can depend on medical necessity, the setting, provider participation, and your plan’s rules. Use the cited publication for the full conditions and check the plan year when comparing costs or enrollment choices.

Prescription drugs (outpatient)

Part B covers a limited number of outpatient prescription drugs under certain conditions. Usually, Part B covers drugs you wouldn’t typically give to yourself, like those you get at a doctor’s office or in a hospital outpatient setting.

Here are some examples of Part B-covered drugs:

Drugs used with some types of durable medical equipment (DME): If the drug used is medically necessary, Medicare covers certain drugs infused through Part-B covered DME (like an infusion pump or nebulizer).
Some antigen allergy tests and treatments: Medicare covers some antigen tests to check for and treat allergies if a doctor or other health care provider prepares them, and they’re given by a properly instructed person (who could be you, the patient) under appropriate supervision.
Injectable osteoporosis drugs: Go to page 81.
Erythropoiesis-stimulating agents: Medicare covers erythropoietin by injection if you have End-Stage Renal Disease (ESRD) or you need this drug to treat anemia related to certain other conditions.
Blood clotting factors: If you have hemophilia (a genetic bleeding disorder that keeps your blood from clotting properly), Medicare covers injectable clotting factors you give yourself or get in a doctor’s office.
Injectable and infused drugs: When a licensed medical provider gives them, Medicare covers most injectable and infused drugs.
Oral End-Stage Renal Disease (ESRD) drugs: Part B covers ESRD drugs you take by mouth.

Note: Part B covers calcimimetic medications, phosphate binders, and other phosphate-lowering drugs for treating ESRD. Your dialysis facility is responsible for giving you these medications either at the facility or through a pharmacy they work with. You’ll need to talk to your dialysis facility staff and your health care provider to find out where you’ll get these medications and how much you’ll pay.

Intravenous Immune Globulin (IVIG): Medicare covers IVIG you get at home if you’ve been diagnosed with primary immune deficiency disease, and your provider decides that it’s medically appropriate for you. Part B also pays for other items and services related to you getting IVIG at home.
Vaccines: Medicare covers flu, pneumococcal, hepatitis B, and COVID-19 vaccines. Medicare also covers some other vaccines when they’re directly related to treating an injury or illness. Go to pages 111–112.
Immunosuppressive drugs: If Medicare helped pay for your organ transplant, Part B covers transplant drug therapy (including standard and compounded immunosuppressive drugs) to prevent organ rejection. You must have Part A at the time of the covered transplant, and you must have Part B at the time you get immunosuppressive drugs.

If you only have Medicare because of End-Stage Renal Disease (ESRD), your Medicare coverage (including immunosuppressive drug coverage) ends 36 months after a successful kidney transplant. Medicare offers a benefit to help you pay for your immunosuppressive drugs beyond 36 months if you don’t have certain types of other health coverage (like a group health plan, TRICARE, or Medicaid that covers immunosuppressive drugs). This benefit only covers your immunosuppressive drugs and no other items or services. It isn’t a substitute for full health coverage. If you qualify, you can sign up for this benefit any time after your Part A coverage ends. To sign up, call Social Security at 1-877-465-0355. TTY users can call 1-800-325-0788.

Oral cancer drugs: Medicare covers some cancer drugs you take by mouth if the same drug is available in an injectable form or it’s a prodrug (an oral form of the injectable drug that breaks down into the same active ingredient after you take it).
Oral anti-nausea drugs: Medicare covers anti-nausea drugs you take by mouth if you take them before, during, or within 48 hours of getting chemotherapy treatment for cancer, or you get them as a full therapeutic replacement for an intravenous anti-nausea drug.
Monoclonal antibodies for treating early Alzheimer’s disease: Go to page 75.

Costs

Doctors, other health care providers, and pharmacies must accept assignment for Part B-covered drugs, so they should never ask you to pay more than the coinsurance or copayment for the Part B drug itself.
In most cases, after you meet the Part B deductible, you pay up to 20% of the Medicare-approved amount for Part B-covered drugs.
Your coinsurance amount can sometimes change depending on your prescription drug’s price.
You might pay a lower coinsurance for certain Part B-covered drugs and biologicals you get in a doctor’s office, pharmacy, or outpatient setting, if their prices have gone up faster than the rate of inflation. The specific drugs and potential savings change every quarter.
If the Part B-covered drugs you get in a hospital outpatient setting are part of your outpatient services, you pay a copayment for the services.
If you get a drug that isn’t covered in a hospital outpatient setting, you pay all costs for the drug, unless you have other drug coverage. If you have other coverage (like Part D), what you pay depends on whether your plan covers the drug and if the hospital’s pharmacy is in your plan’s network. Contact your plan for more specific cost information.
You pay nothing (and the Part B deductible doesn’t apply) for COVID-19, flu, pneumococcal, and hepatitis B vaccines if your provider accepts assignment.
For immunosuppressive drugs, you’ll pay a monthly premium of $121.60 (or higher based on your income) and a $283 deductible in 2026. After you meet the deductible, you pay up to 20% of the Medicare-approved amount for your immunosuppressive drugs.

Things to know Medicare drug coverage (Part D) covers many drugs that Part B doesn’t cover. If you have Original Medicare, you can join a Medicare drug plan to get Medicare drug coverage. If you join a Medicare drug plan, check your plan’s drug list (also called a formulary) to find out what outpatient drugs it covers.

More information Visit Medicare.gov/coverage/prescription-drugs-outpatient.

Insulin

Insulin is a natural hormone that helps maintain healthy blood sugar levels. If you use an insulin pump covered under Part B’s Durable Medical Equipment (DME) benefit, Part B covers insulin used with the pump and the pump itself. Part B doesn’t cover insulin that’s self-administered using pens, disposable insulin pumps (also known as patch pumps) or the insulin used with them, or insulin-related supplies (like syringes, needles, alcohol swabs, or gauze).

If you have a Part D plan, it may cover:

Injectable insulin (insulin you inject with a pen or a needle)
Insulin you use with pumps that aren’t DME, like:
Pumps that are typically changed after 2-3 days (like patch pumps)
Reusable pumps that use disposable insulin cartridges
Insulin that’s inhaled
Certain medical supplies used for insulin injections, like syringes, needles, gauze, and alcohol swabs

Costs

The cost of a one-month supply of each Part D- and Part B-covered insulin product is no more than $35, and you don’t have to pay a deductible for insulin. If you get a three-month supply of insulin, your costs can’t be more than $35 for each month’s supply of each covered insulin product. This means you’ll generally pay no more than $105 for a three-month supply of covered insulin.
Under Part D, the $35 limit applies to everyone who takes insulin, even if you get Extra Help (a Medicare program that helps people with limited income and resources pay Part D costs).
If your Part D plan covers disposable insulin patch pumps, the insulin for your pump won’t cost more than $35 for a one-month supply of Part D-covered insulin. However, the pump itself might cost more than $35.
If you have Part B and Medicare Supplement Insurance (Medigap) that pays your Part B coinsurance, your Medigap policy should cover the cost ($35 or less) for insulin.

More information

Go to:
“Diabetes services” and “Diabetes supplies” on page 35.
“Durable medical equipment (DME)” on pages 41–42.
Visit Medicare.gov/coverage/insulin.
To learn more about Medicare’s Extra Help program, visit Medicare.gov/basics/costs/ help/drug-costs.

Chemotherapy

Chemotherapy is a drug treatment that kills fast-growing cells (including cancer cells) in your body. If you have cancer, Part B covers chemotherapy if you’re a hospital outpatient or get services in a doctor’s office or freestanding clinic. Part A covers it if you’re a hospital inpatient.

Costs

After you meet the Part B deductible, you typically pay 20% of the Medicare-approved amount for chemotherapy you get in a doctor’s office, freestanding clinic, or hospital outpatient setting. If you get chemotherapy in a hospital outpatient setting, your copayment won’t be more than the inpatient deductible amount ($1,736 in 2026).
For Part A inpatient hospital cost information, go to pages 58–59.

More information Visit Medicare.gov/coverage/chemotherapy.

Osteoporosis drugs

If you have osteoporosis, these drugs may prevent further bone loss and help strengthen weak bones. Part A and Part B cover certain osteoporosis injectable drugs and visits by a home health nurse to give you the injections, if you meet all these conditions:

You’re a woman with osteoporosis who:

Meets the criteria for Medicare home health services. Go to “Home health services” on pages 52–54.
Has a bone fracture that a doctor or other health care provider certifies is related to postmenopausal osteoporosis.
Has a health care provider who certifies that you can’t give yourself the injection or learn how to give yourself the injection, and your family members or caregivers are unable or unwilling to give you the injection.

Costs

In most cases, after you meet the Part B deductible, you pay up to 20% of the Medicare-approved amount for covered Part B prescription drugs. Your coinsurance amount can change depending on the drug’s price. You might pay a lower coinsurance amount for certain Part B-covered drugs and biologicals you get in a doctor’s office, pharmacy, or outpatient setting, if their prices have gone up faster than the rate of inflation. The specific drugs and potential savings change every quarter.
You pay nothing for the home health nurse visit to inject the drug.

More information Visit Medicare.gov/coverage/osteoporosis-drugs.

COVID-19 monoclonal antibody treatments & products

COVID-19 monoclonal antibody treatments and products can help you fight mild to moderate COVID-19 symptoms and keep you out of the hospital. Part B covers FDA-authorized or FDA-approved COVID-19 monoclonal antibody treatments and products if you have COVID-19 symptoms.

Costs You pay nothing when you get them from a Medicare provider or supplier. You must meet certain conditions to qualify.

Note: Certain FDA-authorized or FDA-approved monoclonal antibody products can protect you before you’re exposed to COVID-19. If you have Part B and your doctor or other health care provider decides this type of product could work for you (like if you have a weakened immune system), you pay nothing when you get the product from a Medicare provider or supplier.

More information

Go to:
“COVID-19 antibody tests” on page 29.
“COVID-19 diagnostic laboratory tests” on page 29.
“COVID-19 vaccines” below.
Visit Medicare.gov/coverage/covid-19-monoclonal-antibody-treatments-products.
For more on COVID-19, visit CDC.gov/covid.

Source and further reading

Your Medicare Benefits — Centers for Medicare & Medicaid Services. Public domain U.S. government educational material, accessed October 28, 2026. Fynoptic has selected sections, removed print navigation, and reformatted the text for this guide. The agency does not endorse Fynoptic.

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