CMS addresses Part B and Part D drug coverage dilemmas
Executive Briefings Digest, March 21, 2006
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Confusion about eligibility marred the first weeks of the Medicare Part D prescription drug benefit, but patients and providers have also raised questions about another issue: Whether certain drugs should be billed under Part B or Part D.
To help, the Centers for Medicare & Medicaid Services (CMS) in January 2006 released a chart outlining which drug classes fall under which reimbursement category. Although the reference tool does not address all potential situations, it does cover the most frequent B/D coverage determination scenarios facing Part D plans and Part D pharmacy providers.
For example, Part B covers immunosuppressant drugs in case of a Medicare-covered organ transplant. Part D covers these drugs in all other situations, according to the chart. Click here to view the CMS coverage chart.
Source: Hospital Pharmacy Regulation Report
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