Does Medicare Part B Cover Home Injections of Enbrel

[insurance0707]

I have a client losing group coverage and she needs a Med supp and Part D. She's on Embrel self injections from her home. Would that fall under Part B or Part D?

Any info would be appreciated

 

[Chazm]

I have a client losing group coverage and she needs a Med supp and Part D. She's on Embrel self injections from her home. Would that fall under Part B or Part D?

Any info would be appreciated

Does she get it from the pharmacy and inject it at home?

 

[senior-advisor-indiana]

Injections are covered under part d unless they are administered by the doctor or nurse. Then they are usually covered under part b.

 

[Josh]

You can always call the pharmacy too. They know that stuff very well.

 

[senior-advisor-indiana]

You can always call the pharmacy too. They know that stuff very well.

That hasn't been my experience. Pharmacies screw up quite often with the billing of diabetic supplies.

 

[BeeSelective]

at Dr office: Part B

Purchased at pharmacy, self administered at home: Part D

 

[coachd]

It does not cover it. Part D is the only option on this one. She might be able to do a different drug at a dr.'s office. My mother-in-law does this. She goes once a month

 

[insurance0707]

Thanks for the responses....I called Medicare on Sunday and asked them about this. They told me that if the dr orders the enbrel himself and administers it in his office than it is a Part B claim pd 80% by Medicare and the other 20% by med supp. Now the problem is will the client go to the doctors office twice a week to do this when she's perfectly capable of doing it herself at home. For $1100 a month she should really consider it.

 

[senior-advisor-indiana]

Thanks for the responses....I called Medicare on Sunday and asked them about this. They told me that if the dr orders the enbrel himself and administers it in his office than it is a Part B claim pd 80% by Medicare and the other 20% by med supp. Now the problem is will the client go to the doctors office twice a week to do this when she's perfectly capable of doing it herself at home. For $1100 a month she should really consider it.

Thanks for letting me know I was right.

 

[insurance0707]

Yep, you were right - always good to confirm though