Medicare Part B covers doctor visits and outpatient hospital services. Part B also covers the drugs that are infused (given in a vein through an IV) or injected (given as a shot) in a doctor’s office or treatment center. Many chemotherapy (chemo) drugs and the anti-nausea drugs used along with chemo are given by IV infusion in a doctor’s office or clinic. This means they are still covered under Part B.
The difference in coverage for cancer drugs under Medicare Part B and Medicare Part D is blurred when it comes to chemo drugs given by mouth and anti-nausea drugs given by mouth (these are often called oral drugs). Some of these drugs are covered under Part B, but others are covered under Part D.
Some cancer drugs are taken by mouth as part of chemo. For the most part, these drugs are covered under Part B if they are used instead of the same drug that could be given through an IV in your doctor’s office. In other words, if your doctor has a choice between giving you drug by mouth or the same drug as an IV, the oral drug is covered under Part B.
In contrast, oral cancer drugs that cannot be given by IV are covered under Part D
Anti-nausea drugs are often used as part of chemo. The rule for anti-nausea drugs taken by mouth is much the same. If your doctor has a choice between giving you an anti-nausea drug by mouth or through an IV and the drug is given within 48 hours of chemo, then the oral drug is covered under Part B.
Oral anti-nausea drugs that cannot be given through an IV are covered under Part D, not Part B. (If an anti-nausea drug is prescribed for a patient who is not known to have cancer, the drug is covered under Part D, not Part B.)