4. Are all immunosuppressants covered by Part D?

CMS has specified in its Clarification to the Formulary Guidance that “all or substantially all” drugs in six therapeutic categories, including the immunosuppressants, must be covered by all Part D plans.  However, some immunosuppressants have been covered by Medicare Part B in the past.  Medicare Part B will cover them when used for a medically appropriate indication before or after a Medicare Part B-covered procedure, including transplants.  Other use of immunosuppressants (including transplants not covered by Part B) will be covered by Medicare Part D.  Thus, no changes to Part B coverage of immunosuppressants have occurred, despite the implementation of Medicare Part D. 

Reference Information

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