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Prescription Coverage for ESRD patients under Medicare











A patient who undergoes kidney transplant usually needs to take immunosuppressant drugs for the rest of their life to prevent their bodies from rejecting the donor organ. Medicare covers these drugs differently depending on their circumstances. Below are the types of Medicare coverage;
Time-limited Part B coverage                             
If you receive a kidney transplant in a Medicare-approved facility, Medicare Part B will cover your immunosuppressant drugs for 36 months after your hospital departure if:
  •    You had Part A at the time of your transplant
  •    You have Medicare Part B when getting your prescription filled
  •    You are only eligible for ESRD Medicare if your kidney transplant was successful, your       Medicare coverage will end 36 months after the month of your transplant.

If you did not have Medicare when you had a transplant, you can enroll retroactively in Part A within a year of your transplant.

Lifetime Part B Coverage
If you receive a kidney transplant in a Medicare-approved facility, Part B will cover your immunosuppressants for the rest of your life if:
  • ·         You had Part A at the time of your transplant
  • ·         You have Medicare Part B when getting your prescription filled
  • ·         And, you qualify for Medicare based on age or disability


Part D coverage
When you had a transplant, and you had no Part A coverage, your immunosuppressants will be covered by Part D after the transplant. Part D coverage for this type of drug typically means higher costs and additional restrictions, such as having to go to specific in-network pharmacies for your drugs.
All Part D formularies must include immunosuppressant drugs. This means your plan may need to verify that Part B will not cover your drugs before providing coverage. Be sure to look for plans that have the fewest coverage restrictions and that have your pharmacies in the preferred network.

Group health plan Coverage
If you have a group health plan either job-based, retiree, or COBRA coverage, your plan should cover your immunosuppressants during the 30-month coordination period. Medicare will be secondary during this period, however, after 30 months, it will become your primary insurance, and Part D should cover your immunosuppressants.

Vitamins for dialysis patients
Patients on dialysis typically need to take various vitamins after each session to replenish the vitamins in your blood. Medicare usually does not cover vitamin supplements, but some Part D plans may offer enhanced coverage that includes vitamins, however, this Enhanced Part D plans are usually more expensive. Check the plan’s formulary before joining to see if your vitamins are covered.



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