Part B and Part D

tldr: A Medicare supervisor just told me that because I have Part D, Medicare will not cover a prescription under Part B. Huh??

I have Parts A B C and D. My doctor gave me a prescription for a medication (Descovy), which Medicare has covered under Part B since Sept 2024. Under Part B, Medicare covers the full cost of the rx and I pay nothing.

Walgreens initially billed the rx under my Part D, under which I would pay over $700. I called my advantage plan and after two hours they called Medicare with me on the phone, and the Medicare rep said that I was correct, the rx should be billed under Part B at no cost to me. She directed me to contact the pharmacy and have Medicare cover it under part B.

Walgreens gets an error when they bill it under Part B that says I am not eligible for the program. After getting those errors today I called Medicare and spoke to an agent and then a supervisor who said the reason it can’t be billed under Part B is because I am ineligible since I have Part D.

Huh? Having Part D makes me ineligible under Part B? Please tell me that isn’t true! I couldn’t sign up for the advantage plan until I reinstated my Part B (another saga that took 8 months).

So I’m really lost. No one that I’ve spoken to at the advantage plan knows anything about this med being covered under Part B since September. The Medicare rep that they contacted with me on the phone did know the policy change and agreed the med should be covered under Part B. Walgreens gets an error billing it to Medicare. I spent two hours this afternoon talking to Medicare and neither the rep nor the supervisor knew anything. And then the supervisor told me that it can’t be billed under Part B because I have an advantage plan with Part D. I know I could have chosen A and B and simply added Part D instead of an advantage plan, but if D overrides B, I’d be in the same situation.

How do I escape this maddening infinite loop?

ETA Update:

“If you’re in a Medicare Advantage plan, you’ll pay nothing out of pocket for PrEP at any pharmacy in your plan’s network.”

Source: Medicare.gov

I finally found this little nugget on a page on Medicare.gov explaining how PrEP meds are now under Part B even if you have an advantage plan. Now the trick is getting either the pharmacy and/or the insurance to figure out how to bill it so it’s applied through Part B.

I got the pharmacy to call their help desk, who told them to have their specialty pharmacy to handle it. They’ve done so and we’re waiting to hear the results. I also called my advantage plan and they called my doctor’s office with me on the line and asked them to ask the doctor to resubmit the rx through Part B, and we’re waiting to hear back. Hoping this breaks the logjam! Thanks again to everyone for helping to dig through the weeds.