Does Medicare Cover Kidney Transplant Drugs?
Medicare Benefits Solutions
Sep 4, 2022
After undergoing a kidney transplant, patients are required to take prescription immunosuppressant drugs for the remainder of their lives. This is needed to prevent the body from rejecting the new kidney.
Depending on a patient’s specific circumstances, Medicare will cover the costs of these prescriptions differently. In this article, we’ll take a look at the different ways how Medicare will cover your kidney transplant drugs after the surgery is complete.
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Time-limited Medicare Part B Coverage
If your kidney transplant procedure was performed in a facility that’s approved by Medicare, then Medicare Part B will cover the immunosuppressant drugs for a period of 36 months, post-hospital departure.
The drugs will be covered for the 36-month period if:
- At the time of the transplant, you were carrying Medicare Part
- You carry Medicare Part B when heading to the pharmacy to get your prescriptions filled
- You’re only eligible for ESRD (End-Stage Renal Disease) Medicare.
Remember, if the transplant succeeds, Medicare coverage ends 36 months after the month when the transplant was performed. If you didn’t have Medicare coverage when the transplant was performed, you’ll still be able to retroactively enroll in Medicare Part A within one year of the transplant procedure.
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Medicare Coverage for Immunosuppressive Drugs
Can Part B Cover Your Transplant Drugs for the Rest of Your Life? If your kidney transplant was performed in a Medicare-approved facility, Medicare Part B will cover immunosuppressants for the remainder of your life if you meet the following conditions:
- At the time of the transplant, you had Medicare Part A
- You carry Part B when getting prescriptions filled
- You qualify for Medicare based upon a disability or your age
You also have the option of looking into a Medicare Part D plan for additional coverage of your kidney transplant drugs.
Medicare Part D Coverage of Anti-rejections Drugs
If you don’t have Medicare Part A when receiving your kidney transplant, immunosuppressants will have coverage by Medicare Part D after the transplant.
Part D coverage for these types of drugs normally means additional coverage restrictions, such as the requirement that you go to specific pharmacies that are in-network, as well as higher costs.
All formularies for Part D must also include immunosuppressant drugs. However, step therapy isn’t allowed after you’re stabilized on your prescribed immunosuppressant drugs.
Prior authorization may apply.
This means that your plan could need to verify that Medicare Part B won’t cover the prescription prior to providing the coverage themselves. Make sure that you shop for the plans that have the fewest restrictions in coverage and that the pharmacy you go to is in their preferred network of providers.
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GHP Coverage for Kidney Transplant Medications
If you’re carrying a group health plan (GHP) or COBRA coverage, that plan should have coverage for immunosuppressants during the stated 30-month coordination period.
During that period, Medicare is considered secondary. After the 30-month period, Medicare becomes your primary insurance and Part D will cover immunosuppressants.
Dialysis Patients and Vitamins
If you receive dialysis treatments, you’ll normally be required to take a number of different vitamins after each of your dialysis sessions. This is done to help replenish vital vitamins and nutrients in your blood.
Typically, Medicare will not cover vitamins or supplements. However, some Part D plans offer enhanced coverage that may include the cost of vitamins.
Understand that these enhanced Part D Medicare plans are normally on the higher end of the cost spectrum. Make sure that you check each plan’s formulary before you join to verify your necessary vitamins will be covered.
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