Does Medicare cover oral cancer drugs?

Which oral cancer drugs does Medicare Part B cover?

Medicare Part B covers some cancer drugs you take by mouth if the same drug is available in an injectable form, or if it's a prodrug of the injectable drug: an oral form of the injectable drug that breaks down into the same active ingredient after you take it. CMS's Medicare Benefit Policy Manual says that, to be covered under Part B, an oral anti-cancer drug must:

• Be prescribed by a physician or other practitioner licensed under state law to prescribe such drugs as anti-cancer chemotherapy agents.
• Be a drug or biological approved by the Food and Drug Administration (FDA).
• Have the same active ingredients as a non-self-administrable anti-cancer chemotherapy drug or biological that's covered when given incident to a physician's service, with the same chemical or generic name.
• Be used for the same indications, including unlabeled uses, as the non-self-administrable version of the drug.
• Be reasonable and necessary for you.

Does Medicare Part D cover cancer pills that Part B doesn't?

Yes, Medicare drug coverage (Part D) covers many drugs that Part B doesn't cover. All Medicare drug plans must include most drugs in certain protected classes on their drug lists, and cancer drugs are one of those classes. Each plan has its own formulary, so check whether your drug is on it; if you or your prescriber believes none of the drugs on the plan's list will work for your condition, you can ask for an exception.

A drug that Part B covers for cancer isn't paid by Part D for that use. CMS tells Part D plans not to include on their formularies the oral anti-cancer drugs covered by Part B whose only medically accepted indication is as an anti-cancer agent. When such a drug has other medically accepted uses, it can be a Part D drug for those other uses, and pharmacists determine the reason for treatment to decide whether to bill Part B or your Part D plan.

Does Medicare cover anti-nausea drugs taken with chemotherapy?

Yes. Medicare Part B covers anti-nausea drugs you take by mouth if you take them before, during, or within 48 hours of getting chemotherapy for cancer, or you get them as a full therapeutic replacement for an intravenous anti-nausea drug. CMS's Medicare Benefit Policy Manual sets these conditions for oral anti-nausea drugs used as a full replacement for intravenous ones:

• The drug is an oral drug the FDA has approved for use as an anti-nausea (anti-emetic) drug.
• The treating physician gives it, or it's given under the physician's written order, as part of a cancer chemotherapy regimen.
• It's started within 2 hours of the chemotherapy drug and continued no more than 48 hours from that time.
• It's used as a full therapeutic replacement for the intravenous anti-nausea drugs that would otherwise have been given at the time of the chemotherapy.

What do I pay for oral cancer drugs with Medicare?

For Part B-covered drugs, doctors, other health care providers and pharmacies must accept assignment, so they should never ask you to pay more than the coinsurance or copayment for the drug itself. In most cases, after you meet the Part B deductible ($283 in 2026), you pay up to 20% of the Medicare-approved amount. Your coinsurance can sometimes change depending on the drug's price, and you might pay a lower coinsurance for certain Part B drugs whose prices have gone up faster than the rate of inflation.

Under Part D, what you pay depends on your plan. No Medicare drug plan may have a deductible more than $615 in 2026 ($700 in 2027). Generally, after the deductible you pay 25% of the cost as coinsurance until your out-of-pocket spending on covered Part D drugs reaches $2,100 in 2026 ($2,400 in 2027); then you pay nothing out of pocket for covered Part D drugs for the rest of the calendar year. The Medicare Prescription Payment Plan can spread your out-of-pocket costs across the year, but it doesn't save you money or lower your drug costs.

Does Medicare Advantage or Medigap change oral cancer drug coverage?

Medicare Advantage plans must cover all medically necessary services that Original Medicare covers, and most plans include Medicare drug coverage (Part D). A plan may require approval (prior authorization) before it covers certain services or supplies, and rules and costs vary by plan.

With Original Medicare, a Medicare Supplement Insurance (Medigap) policy helps pay your share of out-of-pocket costs in Original Medicare, like copayments, coinsurance and deductibles. Medigap plans sold after 2005 don't include prescription drug coverage; if you want prescription drug coverage, you can join a separate Medicare drug plan (Part D). See how Medicare covers chemotherapy.