Financial Requirements for Transplant Medications Laurie Shore MSW

Financial Requirements for Transplant Medications Laurie Shore, MSW, LCSW Transplant Social Worker (813) 251 -8017 X 1162

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

Commercial, Private & Supplemental § Patients need to know the terms of their policy Ø Review insurance manual Ø Call insurance company

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?

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

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

Medicare & Employee Group Health Plans (EGHP) § Enroll in Medicare A & B even with EGHP Ø To avoid future penalties Ø 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

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

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

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

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

Questions