Medicare Extends Part B Coverage for Kidney Transplant Drugs
Patients with Medicare because of End-Stage Renal Disease (ESRD) currently lose coverage 36 months after a kidney transplant unless otherwise eligible for Medicare. A recently published final rule will extend coverage for patients who meet certain criteria to qualify for continuous Medicare-covered immunosuppressive drugs starting January 1, 2023. This new benefit is called Medicare Part B Immunosuppressive Drug (Part B-ID).
There are a few important limitations to be aware of including:
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- It only covers immunosuppressive drugs and no other items or services
- Patients who have other health coverage are not eligible to enroll
- Patients must provide notice to Social Security Administration within 60 days if they sign up for other coverage
- Patients will be responsible for annual Part B deductible and 20% coinsurance
PAAS Tips:
- Here are some additional resources about Medicare coverage of ESRD
- Patient focused https://www.medicare.gov/basics/end-stage-renal-disease
- Provider focused https://www.cms.gov/partbid-provider
- There are no changes to documentation requirements for DMEPOS suppliers
- See your local DME MAC for resources related to immunosuppressive drug coverage criteria and documentation requirements
Analyst at PAAS National®
As an Analyst, I focus on providing pre- and post-audit assistance, answering various member service questions, and researching & drafting articles for the Third-Party Newsline. I work with many of our members involved with invoice audits.
I obtained my PharmD from the University of Wisconsin-Madison School of Pharmacy and worked for a major chain as well as various LTC and independent pharmacies, before coming to PAAS.
I am passionate about learning and teaching. I strive to learn something new about PBM audits every day, so that PAAS can be more knowledgeable to better serve our members! In 2018, I started traveling to state pharmacy conferences to present audit seminars and meet our wonderful members in person.
I obtained my PharmD from the University of Wisconsin-Madison School of Pharmacy and worked for a major chain as well as various LTC and independent pharmacies, before coming to PAAS.
I am passionate about learning and teaching. I strive to learn something new about PBM audits every day, so that PAAS can be more knowledgeable to better serve our members! In 2018, I started traveling to state pharmacy conferences to present audit seminars and meet our wonderful members in person.
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