Drugs and Biologicals

30 - Drugs and Biologicals (Rev. 1, 10-01-03) A3-3112.4.B, HO-230.4.B See the Medicare Benefit Policy Manual, Chapter 15,”Covered Medical and Other Health Services,” §50 for a description of conditions for coverage for drugs and biologicals. Notwithstanding the instructions in the Medicare Benefit Policy Manual, Chapter 15, “Covered Medical and Other Health Services,” drugs and biologicals furnished to hospital or SNF inpatients who have exhausted Part A benefits, or who are not eligible under Part A, are not covered under Part B except the following: • Hemophilia clotting factors (The limitation contained in 42 CFR 410.10(q) states that this applies to hemophilia patients competent to use these factors without supervision); • Immunosuppressive drugs; • Oral anti-cancer drugs; • Oral drug prescribed for use as an acute anti-emetic used as part of an anti-cancer chemotherapeutic regimen; or • Epoetin Alfa (EPO). Specific coverage for each of the above drugs is found in Medicare Benefit Policy Manual, Chapter 15, “Covered Medical and Other Health Services,” §§50. In addition pneumococcal pneumonia, influenza virus, and hepatitis B vaccines are covered under Part B. See the Medicare Claims Processing Manual, Chapter 18, “Preventive and Screening Services,” and the Medicare Benefit Policy Manual, Chapter 15, for additional information concerning these vaccines.