Financial Requirements for Transplant Medications

1. Financial Requirements for Transplant Medications Laurie Shore, MSW, LCSW Transplant Social Worker (813) 251-8017 X1162

2. Medication Coverage & Insurance • Medications after transplant are expensive • Patients will need to begin planning how they will pay • Will need one or more forms of insurance • Responsible for co-pays/deductibles • Premiums paid by AKF are discontinued following transplantation

3. Commercial, Private &Supplemental • Patients need to know the terms of their policy • Review insurance manual • Call insurance company

4. Insurance Policy Inquiry • What is the cost of medication co-pays? • Is there an annual limit on medications? • Is there a maximum lifetime benefit on the policy? • What is the cost of annual deductibles?

5. Medicare Eligibility • Most patients with ESRD are eligible for Medicare Part A beginning • Hemodialysis – 4th month of treatment • Peritoneal Dialysis & Transplantation – 1st month of treatment or transplant • Length of coverage • Under the age of 65 – provides coverage for 36 months • Over the age of 65 or if disabled for another reason other than ESRD – coverage will continue to be provided

6. Medicare Coverage • Patients must have Medicare Part B for anti-rejection medications to be covered at a percentage • Medicare Part B covers 80% of anti-rejection medications • Patients will be responsible for the remaining 20% for each anti-rejection medication • Additional insurance should alleviate these costs

7. Medicare & Employee Group Health Plans (EGHP) • Enroll in Medicare A & B even with EGHP • To avoid future penalties • Ensure immunosuppressant coverage • Immunosuppressant coverage could change if your employer changes insurance policies • Immunosuppressant coverage could change if you change employers • Immunosuppressant coverage could change at age 65 if Medicare declined at time eligible

8. Medicare Part D • Medicare Prescription Drug Coverage • Medicaid recipients can change plans once a month • Medicare recipients can change plans once a year • Coverage for drugs under Part B will not change • Consider what drugs you may need in the future i.e., Valcyte

9. Medically Needy • Patient Obstacles: • No longer meet share of cost • Must have coverage for 20% of immunosuppressants • 20% out of pocket costs could range from approximately $200-500 per month

10. Military Veteran • If a Veteran with an honorable discharge • Determine eligibility • Establish as a VA patient • Confirm coverage for immunosuppressants • If Medicare and VA only-20% of LifeLink bill arranged by Ins. Verification Dept.

11. Financial Options • Patient options when lacking 20% coverage: • Self pay • Spousal Insurance • Medicaid • Medicare Supplement • Employee Group Health Plan

12. Questions