Immunosuppressive Drugs - Policy Article

Medicare covers immunosuppressive drugs when prescribed for beneficiaries following specified covered transplants (kidney, heart, liver, bone marrow/stem cell, lung, heart-lung), certain pancreas transplant situations, intestinal transplants (post‑2001), and NIH‑trial islet/partial pancreatic transplants (post‑2004), provided statutory R&N and Medicare enrollment/coverage criteria are met. Pancreas-alone transplants (post‑2006) require specific clinical, laboratory, endocrinologist‑managed treatment, and capacity documentation; supply-fee and billing rules (Q0510/Q0511/Q0512) and time-limited coverage (36 months for ESRD-entitlement-only beneficiaries) also apply.

"Immunosuppressive drugs are covered when prescribed following a covered organ transplant of kidney, heart, liver, bone marrow/stem cell, lung, or combined heart-lung."

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