By Laura Lindberg
LTC Industry News
June 05, 2018

Sensipar Added To ESRD Drug List

On August 18, 2017, the Centers for Medicare and Medicaid (CMS)

issued a memo titled, “Sensipar® (cinacalcet) Furnished for the Treatment

of ESRD Moving from Part D to ESRD PPS, Effective January 1, 2018.”

As a result of this CMS direction, the drug Sensipar will be added to the

ESRD drug list and no longer be a Part D drug when prescribed for an

End State Renal Disease (ESRD) member who is receiving renal dialysis

services starting January 1, 2018. This is a unique situation in which a

current Part D drug will no longer be payable under Part D when used for

the provision of renal dialysis services. This change impacts only

members with ESRD, not all utilizers of Sensipar.

As a reminder, drugs dispensed for ESRD-related conditions for members

undergoing dialysis are covered under the Medicare Part B ESRD

bundled payment benefits and are not payable under Medicare Part D per

CMS regulations. Members currently using Sensipar who are not

undergoing dialysis treatment will not be impacted by this change and will

be able to continue therapy without a Part B vs Part D Prior Authorization.

The dialysis treatment indicator on the member’s eligibility is used to

determine whether the member has ESRD.

Author Description

Laura Lindberg

Laura is the Business Office Manager at SCRx Pharmacy. Laura has over 10 years in pharmacy, working in LTC, Hospital and Retail settings.

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