Medicare Part B or Part D for This Drug?
Whether Medicare Part B or Part D covers a drug, and why.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- How the drug is given, or its category
- A vaccine
- Vaccine
- Hepatitis B
- Hepatitis B
- Yes
Result: Part B: hepatitis B vaccine for a person at high or intermediate risk (SSA §1861(s)(10)(B); 42 CFR 410.63(a)), which from 2025 includes anyone who never completed the series.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- How the drug is given, or its category
- On the MAC self-administered drug list
- Vaccine
- Hepatitis B: high or intermediate risk
- Lives at home (for DME drugs)
- Medicare paid for the transplant
- Oral cancer drug matches a Part B injectable
- Antiemetic within 48 hours of chemotherapy
The other 3 fields
- On dialysis
- For a primary immune deficiency
- Permanent digestive dysfunction
How this is calculated
Citation
Social Security Act section 1861(s) (incident-to drugs, DME drugs, vaccines, and the special Part B categories), 42 CFR 410.63, and the CMS Medicare Parts B/D Coverage Issues chart; Part D otherwise, on the plan formulary. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.