Medicare Part B Drug Coverage: Trouble Filling Immunosuppressive Drugs

Posted by rfriend50 @rfriend50, Aug 12 4:55pm

I would like to know if anyone else is having difficulties with filling immunosuppressive drug prescriptions that are covered under Medicare Part B.
It appears as though in my case the agency responsible for approving these is requiring a NEW Prescription each month. Medicare is unaware of this and claims not to have control over the agency. (CGS LLC located in Nashville TN)

Hi @rfriend50 and welcome to Mayo Clinic Connect. I'd like to bring @contentandwell @gingerw @cmael and @danab into this discussion to share their experiences with Medicare and filling immunosuppressive medications post transplant. While we wait for others to respond, you may be interested in reading this discussion:
– What are the financial challenges after transplant with medicare? https://connect.mayoclinic.org/discussion/finance/

Rfriend50, is this a recent change that a new prescription is required every month?

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@colleenyoung

Hi @rfriend50 and welcome to Mayo Clinic Connect. I'd like to bring @contentandwell @gingerw @cmael and @danab into this discussion to share their experiences with Medicare and filling immunosuppressive medications post transplant. While we wait for others to respond, you may be interested in reading this discussion:
– What are the financial challenges after transplant with medicare? https://connect.mayoclinic.org/discussion/finance/

Rfriend50, is this a recent change that a new prescription is required every month?

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Yes. The first time was June 8, and the second time last week. Medicare claims it is an action by CGI llc. who handles the claims. The Walmart pharmacy is helpful but when they submitted the refill order it was rejected and they were told they need NEW prescription each month.

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@colleenyoung

Hi @rfriend50 and welcome to Mayo Clinic Connect. I'd like to bring @contentandwell @gingerw @cmael and @danab into this discussion to share their experiences with Medicare and filling immunosuppressive medications post transplant. While we wait for others to respond, you may be interested in reading this discussion:
– What are the financial challenges after transplant with medicare? https://connect.mayoclinic.org/discussion/finance/

Rfriend50, is this a recent change that a new prescription is required every month?

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@rfriend50 @colleenyoung My husband recently went on Medicare. He was transplanted with new-to-him kidney Oct 2016. His insurance until end of May this year, was Kaiser Permanente. You may want to check about a different prescription drug plan, to cover your medications. He has signed up with a Plan G provider, and so far has had no issue. He has a fair supply of his current meds coming in to this coverage, and has not needed to avail himself of the plan, yet. It may be because of the expense of medications, or your time out from transplantation. When was your surgery?
Ginger

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@rfriend50

Yes. The first time was June 8, and the second time last week. Medicare claims it is an action by CGI llc. who handles the claims. The Walmart pharmacy is helpful but when they submitted the refill order it was rejected and they were told they need NEW prescription each month.

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@rfriend50 Let your transplant team know the troubles you are having. They will not want any lapse in your medications to happen, especially if the cause is paperwork!
Ginger

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I get my prescriptions from the VA with 90 day refills.
Medicare should also handle 90 day prescriptions, with a new Rx every 6 months. It sounds like the problem is with the provider. If the provider cannot get this right, check with your Medicare plan. Transplant recipients cannot tolerate this poor service.

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@rfriend50 Hi and yes im on Medicare both a and b but I also am retired military and have a supplement called Tricare for Life. The Meds are covered thru Tricare via a program called express scrip. I just started getting my meds thru them and have not needed my one immunosuppressive yet Tacrolimus. So im not sure if Medicare itself covers immunosuppressants.
Also tho like @azdan99 mentioned if you have had any military time you may be able to get them thru the VA.
I hope that helps
Have a Blessed Day
Dana

Liked by azdan99

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@colleenyoung

Hi @rfriend50 and welcome to Mayo Clinic Connect. I'd like to bring @contentandwell @gingerw @cmael and @danab into this discussion to share their experiences with Medicare and filling immunosuppressive medications post transplant. While we wait for others to respond, you may be interested in reading this discussion:
– What are the financial challenges after transplant with medicare? https://connect.mayoclinic.org/discussion/finance/

Rfriend50, is this a recent change that a new prescription is required every month?

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I have a Medicare advantage plan with Humana. I’ve never had any problem getting 90 day prescriptions. I still get my Tacro, Cellcept and Prednizone from Mayo specialty pharmacy. I have other prescriptions that I get from Humana pharmacy. I have a 0% copay for most, but the immunosuppressants from Mayo have a small co pay.

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@danab

@rfriend50 Hi and yes im on Medicare both a and b but I also am retired military and have a supplement called Tricare for Life. The Meds are covered thru Tricare via a program called express scrip. I just started getting my meds thru them and have not needed my one immunosuppressive yet Tacrolimus. So im not sure if Medicare itself covers immunosuppressants.
Also tho like @azdan99 mentioned if you have had any military time you may be able to get them thru the VA.
I hope that helps
Have a Blessed Day
Dana

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Hi Dana. My husband is retired military. He is not old enough yet for the Tricare for life, but we have Tricare Select along w a supplement company and I have never had any problems getting my Prograf through Express Scripts.

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@cmael

I have a Medicare advantage plan with Humana. I’ve never had any problem getting 90 day prescriptions. I still get my Tacro, Cellcept and Prednizone from Mayo specialty pharmacy. I have other prescriptions that I get from Humana pharmacy. I have a 0% copay for most, but the immunosuppressants from Mayo have a small co pay.

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That is different coverage. If you were covered by medicare at the time of your transplant, your immunosupressive drugs are covered under Part B in a special section of Medicare. There is no co-pay for this coverage but you are limited to 30 day perscriptions.

Liked by azdan99

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@colleenyoung

Hi @rfriend50 and welcome to Mayo Clinic Connect. I'd like to bring @contentandwell @gingerw @cmael and @danab into this discussion to share their experiences with Medicare and filling immunosuppressive medications post transplant. While we wait for others to respond, you may be interested in reading this discussion:
– What are the financial challenges after transplant with medicare? https://connect.mayoclinic.org/discussion/finance/

Rfriend50, is this a recent change that a new prescription is required every month?

Jump to this post

I'm glad I live in Ontario Canada. If you don't have medical coverage at work the Trillium Program kicks in and pays for your prescriptions 😃

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What pharmacy are you using? That would be helpful to the group so we can make sure we don’t use them

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Hi, @rfriend50 I had my transplant almost four years ago and have had no trouble with filling my immunosuppressant prescriptions monthly. They will only do a month at a time but they always fill in plenty of time. The prescriptions are filled by a CVS specialty pharmacy in Boston and sent to me via UPS. I live in southern NH. Right now I’m in Maine and they were due so they sent them to a CVS up here.

My copay is negligible.
JK

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