Question:

What does the term “by the patient” mean?

Answer:

The term “by the patient” means Medicare beneficiaries as a collective whole. The A/B MAC (B) includes only the patients themselves and not other individuals, which CMS defines as spouses, friends, or other caregivers. The determination is based on whether the drug is self-administered by the patient a majority of the time and whether it is used on an outpatient basis by Medicare beneficiaries for medically necessary indications. The A/B MAC (B) ignores all instances when the drug is administered on an inpatient basis.

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