After you get a kidney transplant, you will need to take immunosuppressive drugs for the rest of your life. How Medicare covers immunosuppressive drugs after your transplant depends on why you are entitled to Medicare and when you received your transplant.
Medicare Part B coverage for the rest of your life
Medicare Part B will cover your immunosuppressive drugs after a kidney transplant once you leave the hospital for the rest of your life if:
- You had Part A when you got the kidney transplant
- You got the transplant in a Medicare-covered facility
- You qualify for Medicare based on age or disability and have Part B when you get the drug
Medicare Part B coverage for a limited time
Medicare Part B will cover your immunosuppressive drugs after you leave the hospital following a kidney transplant for 36 months if:
- You had Part A when you got the transplant
- You got it at a Medicare-certified facility
- You have Medicare Part B when you get the prescription filled and
- You are entitled to Medicare solely because of ESRD
- If you have had a successful kidney transplant, your Medicare coverage will end 36 months after you had the transplant and Medicare will no longer cover your immunosuppressive drugs. A transplant is considered successful if it lasts for 36 months without rejection.
Note: If you did not have Medicare when you had a transplant, you can enroll retroactively in Part A if it is within a year of your transplant.
Medicare Part D coverage
Part D will cover your immunosuppressive drugs for ESRD if they are not covered by Part B because you did not have Medicare at the time of your kidney transplant. All Part D formularies must include immunosuppressive drugs. Step therapy is not allowed once you are stabilized on your immunosuppressant drug. However, prior authorization can apply to verify that Part B won’t cover your drugs even after you are stabilized on them. Double check to make sure the drugs you need are covered with the fewest restrictions and that your plan includes your pharmacy as a preferred network pharmacy.
If you have employer coverage
If you have employer insurance (current employer, retiree or COBRA) Medicare coverage of immunosuppressant drugs might be different. For the first 30 months of your Medicare eligibility, your employer insurance will pay primary and Medicare will pay secondary. This means that your employer insurance should cover the cost of your immunosuppressive drugs until you reach the end of your 30-month coordination period and Medicare begins to pay first. If you are unsure about how Medicare will work with your employer insurance, contact your employer’s benefits administrator or call 1-800-MEDICARE.
Vitamins for dialysis patients
After each dialysis session, someone with ESRD needs to take various vitamins since dialysis removes vitamins from the blood. Medicare will not usually cover these vitamin supplements.
- Part B does not provide coverage for vitamins.
- If the vitamins require a prescription, Part D plans with basic coverage will not cover them. However, some Part D plans offer enhanced coverage that specifically covers these vitamins. You typically pay more for enhanced Part D plans. Make sure you check the plan formulary and contact the plan before joining to ensure it will cover all the vitamins you need. You should confirm each year, during Fall Open Enrollment that the plan will continue to cover your vitamins.