Elimination of Time Limits for Immunosuppressive Drugs Covered by Medicare

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TO: All KHC Transplant Recipients, Transplant Coordinators, Participating Pharmacy Providers
FROM: Phillip W. Walker, Chief, Bureau of Kidney Health Care
DATE: March 16, 2001
SUBJECT: Elimination of Time Limits for Immunosuppressive Drugs Covered by Medicare

The Benefits and Protective Act, as signed by President Clinton in December 2000, eliminated the time limit for coverage of immunosuppressive drugs (ISD) for Medicare entitled beneficiaries (based on age 65 and older or disability) who are eligible for Medicare ISD coverage. There is no longer any time limit for ISDs furnished on or after December 21, 2000. Current Medicare beneficiaries who had Medicare ISD coverage in the past, but lost their ISD coverage due to time limits, may resume receiving the Medicare ISD coverage for drugs furnished on or after December 21, 2000.

This change in law does not apply to Medicare beneficiaries who are eligible for Medicare based solely on a kidney condition. KHC will continue to provide ISD coverage for these patients when they lose their Medicare benefits.

Due to the April 1, 2001 Medicare implementation date, KHC is implementing the following policy and procedures for coverage of immunosuppressive drugs:

*  Beginning April 1, 2001, KHC will only provide ISD coverage for KHC recipients who are not eligible for Medicare ISD coverage.

*  Patients must call KHC at 1-800-222-3986 to let us know their current Medicare number or status by April 20, 2001, to avoid a delay in KHC ISD coverage.

*  Patients who resume their eligibility for Medicare ISD coverage should contact their pharmacies to determine if the pharmacy is a Medicare provider. If the pharmacy is not a Medicare provider, patients may call KHC for Medicare pharmacy providers listed in the state.

*  Refunds of KHC claim payments for patients eligible for Medicare ISD coverage may be requested from a pharmacy regardless of whether the pharmacy is a Medicare provider.

*  Patients who are eligible for Medicare based on a kidney condition must notify KHC if they become eligible for Medicare based on disability to avoid any potential liability for previous KHC claims payments.

*  Please call KHC at 1-800-222-3986 if you have any questions.


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Last updated February 22, 2011