Medicare Coverage for Prograf

IV Prograf

Prograf injection is typically covered under Part A or Part B, depending on the site of service where it is provided to the patient.

Oral Prograf

Coverage for Prograf capsules depends, in part, on how the patient qualifies for Medicare. The type of transplant the patient has received helps determine this.

Prograf capsules can be covered under either the Part B or Part D benefit, depending on the patient circumstances. The following table explains when coverage for Prograf is available under each of these benefits.

Part B Part D

Covered under Part B when all of the following conditions are met:

  • Prograf is prescribed following a Medicare-covered transplant
  • The patient was enrolled in Medicare Part A at the time of the transplant and is enrolled in Medicare Part B at the time that the drugs are dispensed
  • Medicare paid for the transplant or Medicare was the patient's secondary payer at the time of the transplant
  • Prograf is medically necessary to prevent rejection of an organ transplant in the particular patient
  • Prograf is furnished on or after the date of discharge from the hospital following a covered organ transplant

Under circumstances when Part B does not cover immunosuppressants, Prograf is usually covered under the Part D benefit.

An example of this would be:

  • Prograf is being used for immunosuppressive therapy BUT patient did not receive a Medicare-approved organ transplant.

The patient must have chosen and joined a Part D plan and be paying monthly Part D premiums, and Prograf must be a covered drug on the patient's Part D plan.


PLEASE SEE INDICATION AND IMPORTANT SAFETY INFORMATION INCLUDING BOXED WARNING HERE.
PLEASE SEE FULL PRESCRIBING INFORMATION HERE.

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