Most costs associated with home infusion therapy fall under Medicare Part B benefits.
However, keep in mind that insulin pump systems are not considered home infusion therapy and fall under Medicare Part D. You can read more about Part D plans offering coverage for insulin pumps in our FAQ:
Will my Medicare Part D plan cover my insulin pump?
To compare how a medication is covered by all Medicare Part D plans in a service area, see
Q1Rx.com.
To be eligible to receive home infusion therapy services under the home infusion therapy benefit,
a beneficiary must have Medicare Part B and meet each of the following requirements:
- The beneficiary must be under the care of an applicable provider, as defined in
section 1861(iii)(3)(A) of the Act as a physician, nurse practitioner, or physician
assistant.
- The beneficiary must be under a physician-established plan of care that meets the
requirements specified in 42 CFR 414.1515 and 42 CFR 486.520, as described in
section 320.5 of this chapter.
Question: Which drugs and biologicals are considered "home infusion drugs"?
CMS states:
"'Home infusion drugs' are defined as parenteral drugs and biologicals administered intravenously, or subcutaneously for an administration period of 15 minutes or more, in the home of an individual through a pump that is an item of DME covered under the Medicare Part B DME benefit... '[H]ome infusion drugs' does not include insulin pump systems or self-administered drugs or biologicals on a self-administered drug exclusion list."