Article Detail - JF Part B
Medicare Part B Immunosuppressant Drug (PBID) New Benefit
Effective January 1, 2023, a new benefit is available for certain individuals with Medicare coverage for End-Stage Renal Disease (ESRD) coverage only. Individuals that have received a kidney transplant may need an extension of Medicare coverage for immunosuppressant drugs once they have exhausted their 36 months of coverage.
Consolidated Appropriations Act (CAA) of 2020 allows individuals whose Medicare entitlement based on ESRD ends 36 months after the month in which they received a successful kidney transplant to continue enrollment under Medicare Part B only for the coverage of immunosuppressive drugs described in section 1861(s)(2)(J) of the Act without a time limit.
Individuals entitled to PBID, would not receive Medicare coverage for any other items or services, and would only be eligible for the immunosuppressive drug coverage if they are not enrolled in certain other types of coverage (e.g., group health plan, TRICARE, or a Medicaid state plan that covers immunosuppressive drugs). Coverage for premiums and cost sharing may be available for some individuals.
Claims for the immunosuppressive drug would be submitted through the Durable Medical Equipment contractor.
