Wellcare CalViva Health Dual Align (HMO D-SNP): Medicare Part B Prescription Drugs

Original Medicare Part B prescription drugs are covered.*  Part B prescription drugs include:

• Injections in a provider's office

• Drugs used with some types of durable medical equipment (like a nebulizer or external infusion pump)

• Certain oral anti-cancer drugs

• Intravenous Immune Globulin for use in the home

• Certain drugs administered in a hospital outpatient setting (under very limited circumstances)

*Other than the examples above, the member pays 100% for most drugs unless they have a Part D plan (prescription drug coverage) or other drug coverage.

For some drugs with an external infusion pump, and for intravenous Immune Globulin for use in the home, services like nursing visits may also be covered under the Home Infusion Therapy benefit and the Immune Globulin benefit. Part B also covers some injectable or implantable drugs to treat substance use disorder when a provider administers it in their office or at a hospital as an outpatient.

There are no copayments for these services if the member gets them from a Medicare-enrolled opioid treatment program.

Providers and pharmacies must accept assignment for Part B-covered drugs, so the member should never be asked to pay more than the coinsurance or the copayment for the Part B drug itself.

The member's coinsurance can change depending on the prescription drug's price. They might pay a lower coinsurance for certain drugs and biologicals covered by Part B that they get in a provider's office, pharmacy, or hospital outpatient setting if their prices have increased higher than the rate of inflation. The specific drugs and potential savings change every quarter.

Note that all Medicare Advantage plans (sometimes referred to as “Part C”) are required to provide the same coverage as Original Medicare, which includes all benefits in Part A and Part B.  For Part D (prescription drug plan), however, coverage may vary depending on the plan purchased.