Medicare Q&A
Q: Medicare covered my patient's kidney transplant. If my patient is eligible for Medicare due to ESRD, is he/she only eligible for coverage for Prograf for 36 months after the transplant?
A: Perhaps. Your patient remains eligible for Medicare for 36 months after a successful kidney transplant. After 36 months, to continue Medicare eligibility, your patient must meet criteria for disability provisions if he/she is under age 65. When your patient reaches age 65, he/she will be eligible for Medicare again. At any time that the patient has Medicare coverage, AND is taking Prograf because of the transplant, he/she is eligible for coverage for Prograf under Part B because his transplant was Medicare-approved.
Q: My patient has both Part B and Part D. Can he/she choose the benefit between these two to access Prograf?
A: No. If your patient had a Medicare-covered transplant and is taking Prograf® because of the transplant, he/she must access Prograf under Part B. If the coverage for Prograf does not lie under Part B, as determined by the rules provided in the coverage table, he/she must access Prograf under Part D.
