Medicare Part D Provider Enrollment Separate From Part B

Medicare reports some confusion among Medicare Part B physicians and pharmacies regarding the ability of Medicare Part B providers to bill for drugs covered under Part D, the Medicare prescription drug program.

In short, being an enrolled provider in the Medicare Part B program does not impart Part D-related billing privileges. Providers must have a separate contractual relationship with a patient's Medicare prescription drug plan to receive payment for the patient's covered prescription drugs.

Medicare Part B covers a limited number of prescription drugs and biologicals that generally fall into three categories:

  • Drugs furnished incident to a physician's service;
  • Drugs furnished through a Medicare Part B covered item of durable medical equipment (DME); and
  • Drugs specifically covered by statute (for example, oral immunosuppressive drugs).

These drugs will continue to be covered and paid for under Part B after the Jan. 1, 2006, effective date for Part D.

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