Immuno coverage for Medicare patients coming later this year

The Department of Health and Human Services (HHS) recently took an important next step toward implementing legislation Congress passed in December 2020 to ensure kidney transplant recipients have continued access to immunosuppressive drugs that help protect their new kidney. The new benefit, the result of advocacy by NKF patients, caregivers, and health professionals, provides indefinite Medicare coverage of immunosuppressive drugs for kidney transplant recipients whose Medicare eligibility ends 36 months after receiving their transplant.

Kidney recipients whose coverage has expired and do not have immunosuppressive coverage can enroll starting on October 1, 2022. Their coverage will then resume on January 1, 2023. The monthly premium will be 15% of the Part B premium for Medicare beneficiaries age 65 and over and the standard 20% co-pay will apply. The new law removes the 36-month limitation only for immunosuppressive drugs, but all other Medicare coverage ends 36-months after the transplant. If you are 65 years old or older or if you have Medicare coverage due to another disability, your Medicare coverage will continue, including for immunosuppressant medication.

What Patients Need to Know

Kidney recipients who have other insurance coverage that contains an immunosuppressive benefit who have reached their 36-month limit are ineligible for the extended Medicare benefit. This includes group health insurance or individual insurance, Medicaid, Affordable Care Act (“Obamacare”) coverage, Veterans Administration coverage, or TRICARE (civilian Armed Forces personnel and retirees). If someone has one of these types of policies but loses it in the future, they will be able to re-enroll in Medicare at that time for coverage of their transplant immunosuppressive drugs only.

NKF is thrilled that this new coverage will allow more people to access immunosuppressant medication and keep their kidney transplants. NKF will continue to make patient voices heard by offering comments on the Proposed Rule to meet the needs of kidney recipients and their families, and will share additional information on enrollment when it becomes available.