Self-Administered Drugs

Self-administered drugs for Medicare outpatients are not covered under Part B, but may be covered under Part D. CMS provides general guidance on self-administered drugs indicating that ““Self-administered drugs” are medications that beneficiaries would normally take on their own, like medications that are taken every day to control blood pressure or diabetes. In most cases, Part B generally doesn’t pay for self-administered drugs used in the hospital outpatient setting.
(CMS publication-June 2020)

Each Medicare Administrative Contractor (MAC) publishes a list of injectable products that are considered “self-administered” and therefore not covered for a Medicare Outpatient. Links to each MAC list is below
(current as of 04/21/2021):

CGS Administrators, LLC (A52527)
First Coast Service Options, Inc. (A52571)
National Government Services, Inc. (J-K) (A53021)
National Government Services, Inc. (J-06) (A53022)
Noridian Healthcare Solutions, LLC (J-E) (A53032)
Noridian Healthcare Solutions, LLC (J-F) (A53033)
Novitas Solutions, Inc. (A53127)
Palmetto GBA (A53066)
Wisconsin Physicians Service Insurance Corporation (A52800)

OIG Policy on Discounts and Waivers

The OIG published a policy, “OIG Policy Statement Regarding Hospitals That Discount or Waive Amounts Owed by Medicare Beneficiaries for Self-Administered Drugs Dispensed in Outpatient Settings” on October 29, 2015. This document outlines requirements where a hospital may discount or waive charges for self-administered drug owed by Medicare beneficiaries.

Medicare Benefit Policy Manual (100-02), Chapter 15-Covered Medical and Other Health Services, Sections 50.2 and 50.3