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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    Y ou are only eligible for ESRD Medicare i f your kidney transplant was successful , your       Medicare  coverage will end   36 months after the month of yo...

FAQs on Medicare and ESRD

I have ESRD. Am I eligible for Medicare? You can apply for Medicare no matter how old you have all of these: ·          Your kidneys no longer work ·          You need regular dialysis or have had a kidney transplant ·          One of these applies to you: ·        You've worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee ·        You’re already getting or are eligible for Social Security or Railroad Retirement benefits ·     You’re the spouse or dependent child of a person who meets either of the requirements listed above. You may contact  Social Securit y  for more information. If you get benefits from the Railroad Retirement Board (RRB), call 1-877-772-5772. I’m on kidney dialysis or ...

Medicare Advantage Plan on ESRD

While payers and Medicare Advantage proponents applauded elements of the Medicare Advantage rule which will increase plans’ revenues by nearly one percent, many expressed concerns about the proposed rule’s approach to chronic disease management costs for patients with E nd-stage renal disease (ESRD) . The  proposed rule  mainly focuses on prescription drug pricing . It gives Part D plans the ability to negotiate pricing, promote less expensive generic through a new specialty tier, and allow patients to compare drug prices for the one that best fits their needs and wallet. But aside from that, this proposed rule also addresses   the population of patients with the severe stage of chronic kidney disease called end-stage renal disease in which until now has been largely excluded from Medicare Advantage coverage. End-stage renal disease is a serious condition that requires invasive and urgent chronic disease management. At this stage, the organs have completel...