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Self-Administered Drugs and Medicare in an Outpatient Setting

Medicare DOES NOT allow for payment of self-administered drugs on an outpatient basis.

What are self-administered drugs?

Medicare defines Self-Administered Drugs as medications taken by mouth, suppositories, creams, ointments, eye drops, eardrops and self-injectables, such as insulin.

What is considered to be an outpatient visit?

An outpatient visit is any emergency room visit, diagnostic testing, therapy visit, same day surgery or outpatient observation stay. Even though your physician may have you stay in the hospital overnight, this may be considered an outpatient observation stay. To be certain of your classification, you need to ask your nurse for clarification. If you are not admitted as an inpatient, you are receiving outpatient services.

What does this mean?

You will be billed for any self-administered drugs you received on an outpatient basis. Neither Medicare nor your supplement will pay for these
medicines/drugs. Also, you may not bring your own medicines to the hospital to take, as we are unable to ensure that your medicine is the exact medicine and dosage prescribed by the physician.

For further clarification from Medicare, you can contact them by calling: 800.633.4227

The information provided is based on Medicare regulations and guidelines.


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