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How are self-administered drugs covered under Medicare Parts A and D during hospitalization?

Self-administered drugs during an inpatient (Part A) hospital stay are covered by Part A. Self administered drugs taken during an outpatient (Part B) hospital stay should be covered by Part D as would drugs received upon discharge from a hospital. Part D drugs that are taken during an outpatient hospital stay that are unrelated to the precipitating diagnosis would be covered by a Part D plan's out-of-network coverage rules. If the drug is on the plan's formulary, the beneficiary can submit the bill from the hospital pharmacy (rarely a Part D participating network pharmacy) to the Part D plan for coverage at the plan negotiated price (see the Plan Finder).

 

Source: The Medicare Benefit Policy Manual http://www.cms.hhs.gov/manuals/Downloads/bp102c01.pdf 


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