Sensipar® for End-Stage Renal Disease (ESRD): No Longer Reimbursable Separately Under Medicare Part D
Posted January 30, 2018
Effective Jan. 1, 2018, the Centers for Medicare & Medicaid Services (CMS) determined the drug Sensipar will no longer be separately reimbursable under the Medicare Part D benefit when administered for hemodialysis. Instead, members with ESRD may be able to continue to receive coverage for Sensipar therapy from their dialysis center within the bundled hemodialysis payment.
Members who are receiving Sensipar as part of their hemodialysis treatment should be referred to their nephrologist and/or dialysis center to discuss treatment options. If a member is not using Sensipar to treat an ESRD condition, the coverage change with Sensipar does not affect the approval for the drug. These members can continue receiving coverage for the drug at their pharmacy under their Part D coverage.
For additional information, contact your assigned Provider Network Consultant (PNC).
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The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.