Frequently asked questions about medicare identified self-administered drugs
What are Medicare self-administered drugs?
Generally, the oral and topical prescriptions and over-the-counter drugs you get in an outpatient setting like an emergency department, outpatient department, or the clinical decision unit are identified as “self-administered drugs” by Medicare and aren’t covered by Medicare Part B. If you have Medicare Part D prescription drug coverage, these drugs may be covered under certain circumstances. You will likely need to pay out-of-pocket for these drugs and submit a claim to your drug plan for reimbursement. Call your Medicare Part D plan provider for more information.
Community Hospital is not a Medicare Part D provider and cannot submit a claim for payment.My doctor told me that I was admitted and I stayed one or more nights in the hospital.
Being “admitted” does not necessarily mean you met Medicare inpatient criteria, as set forth in thefederal Medicare regulations. Even though you may have stayed one or more nights in the hospital, this date of service did not meet inpatient level of care standards, as defined by Medicare.
Why do I have to pay for these medications?
As detailed in your Medicare Hand Book, which is provided to you each year, Medicare does not cover certain medications given in an outpatient setting.
Is financial assistance available to me if I am unable to pay for my self-administered drugs?
Yes, Community Hospital has a Sponsored Care program, based on the federal poverty guidelines. If you qualify, you may be eligible for up to 100 percent financial assistance for these medications, depending on your income. Call (831) 625-4922 to discuss financial assistance and repayment options.
Note that Sponsored Care is always the payment source of last resort, so if you have Medicare Part D coverage, that must be applied before any adjustments can be made to your account.
What happens to medication ordered by a doctor that is not taken by the patient?
If medication is ordered but for some reason is not administered to the patient, the patient is not
Why can’t patients bring their own prescription medications to the hospital?
To ensure patient safety, Community Hospital does not allow patients to bring medication from home unless the hospital pharmacy cannot provide the medication. By law, each medication brought in by a patient must be identified by a hospital pharmacist and visually evaluated for integrity before it could be administered in a hospital. Most importantly, we have many safety checks and balances in place that depend on the medication being in unit-of-use packaging to ensure that patients receive the right medication at the right time in the right dose. In addition, since May 2012, all medications musthave a bar code that will be scanned by the patient’s nurse at the time of administration to create both the documentation and the charge.
Why are medications from the hospital pharmacy more expensive than the same or similar medications from a retail pharmacy?
It is difficult to compare charges for drugs from a hospital pharmacy and those of a retail store.
A hospital is always open and staffed by doctors, nurses, and other clinical support staff members who are caring for very sick patients and available for emergency situations. Our overhead costs are more than a retail pharmacy, therefore our charges are more than a retail pharmacy.
Why isn’t there a standard percentage mark up for all medications provided by the hospital pharmacy?
Our pricing is based in part on the cost of the medication and they method for administering it.
Why does Community Hospital use generic medications in some cases and brand names in other cases?
The medications we use are primarily purchased through a group contract to achieve the best prices. In some cases, the contract provides generic drugs and in others, brand name.