astellasreimbursement

Medicare has established specific requirements that define a Medicare-covered transplant. Requirements that the transplant must meet for coverage approval include:

• Patient is entitled to Part A at the time of transplant
• Transplant is performed at a facility that is Medicare-approved for transplants at the time

CMS and local Medicare contractors may establish additional requirements that pertain to coverage of transplants. Specific conditions that patients must meet vary depending on the type of transplant. It is important to confirm coverage requirements for transplants as specified in published policies.

Coverage for immunosuppressive medications depends, in part, on how the patient qualifies for Medicare. Patients who are being treated with an immunosuppressive agent can receive their immunosuppressive drugs for their entire lifetime, as long as they are currently enrolled in Medicare Part B and had a Medicare-approved transplant.

Transplant Type and Medicare Pathway
Type of Transplant		Kidney		Liver, Heart, Lung, or Other Organs
Medicare Pathway		ESRD		Disability or Aged 65+
Medicare Eligibility Impact		Patients remain eligible for Medicare for 36 months after a successful kidney transplant. To continue being eligible for Medicare, patients must qualify for coverage through another basis for Medicare eligibility, such as reaching the age of 65 or otherwise qualify for Medicare under disability provisions.		Continued access to benefits depends on enrollment in and monthly premium payment for Parts A and B, or Part D.