Supply Allowance for Immunosuppressive Drugs

Effective for claims with dates of service (DOS) on or after January 1, 2025, the CMS finalized policy to allow payment of a refill of a prescription under the Immunosuppressive Drug Benefit for up to a 90-day supply. The final rule is based on individual circumstances respective of applicable State laws and regulations. A narrative is required on the claim to indicate a 90-day supply. Medical records are expected to support the need for the care provided.

For DOS prior to January 1, 2025, the quantity of dispensed medically necessary immunosuppressive drugs is limited to a 30-day supply.

Refer to Local Coverage Determination (LCD) L33824 for more information.

Last Updated Apr 14 , 2025