• Medicare To Pay for Anti-rejection Maintenance Drugs

    Posted by mike-spisak on January 2, 2021 at 4:52 am

    Thank you so much for this clearing house of vital information and support while I learn to navigate through the all the testing, meetings and emotional issues connected to my IPF.

    As you can imagine I have been bombarded with information from the Cleveland Clinic Transplant Team concerning a much needed double lung transplant. I just started all the testing, having spent two full days at their Main Campus and getting a chance to meet everyone. One of my biggest concerns is the finical burden of all of the different anti-rejection drugs one must take for the remainder of your life. Being that I will be receiving this life saving procedure, (God Willing), under Medicare, would someone happen to know if these anti-rejection drugs such as Tacrolimus, Cellcept, Posaconazole, etc have their cost covered under Medicare for the rest of my life? I seem to be finding conflicting information concerning this. Anything information to help enlighten myself and my wife would be greatly appreciated.

    les-viegas replied 2 years, 8 months ago 3 Members · 6 Replies
  • 6 Replies
  • charlene-marshall

    January 4, 2021 at 12:33 pm


    Hi Mike,

    So nice to hear from you, and thanks for sharing a bit about your experience (and concerns) re: transplantation at Cleveland Clinic. @mark-koziol is your guy to speak to about that transplant center, as that is where he received his transplant. Mark, when you have a moment, can you connect with Mike? Sounds like you could be of great help to him 🙂


  • mike-spisak

    January 4, 2021 at 1:39 pm

    Hi Charlene,

    Mark is way  ahead of you. We exchanged phone numbers and already talked about things in common and about both living in Cleveland.

    Thank you so much for the warm welcome and I am looking forward to using the knowledge that is now key strokes away to better understand this horrible disease.

  • charlene-marshall

    January 4, 2021 at 1:43 pm

    Hi Mike,

    Wonderful to hear this! I have no doubt he will be super helpful to discuss all things Cleveland and transplant. Please let us know if you have any other questions, and welcome again. I’m glad you’ve found this site as a resource!
    Kind regards,

  • les-viegas

    January 5, 2021 at 4:09 pm

    Hi MIke,

    I too received my lung transplant from Cleveland Clinic several years ago and have first-hand experience with Medicare’s rules for covering drug costs. Medicare (Part B not Part D) covers the full cost of anti-rejection drugs as well as Prednisone IF your transplant costs were paid for by Medicare. In order to take advantage of this benefit, you should fill your prescriptions through a Specialty Pharmacy and not a retail pharmacy. The reason is that the specialty pharmacies are knowledgeable in the rules for filing Master Medical claims wiht Medicare. You will still need to get the rest of your prescriptions from a retail pharmacy and be subjected to the usual “donut” hole, etc copay provisions if you have enrolled in Part D. And some of those plans are available for around $ 35/month excluding copays.

    If this terminology is confusing, I would be happy to discuss it in detail at your convenience.

    Best wishes for a successful transplant.


  • mike-spisak

    January 6, 2021 at 8:36 am

    Hi Les,

    Thank you for the solid info. I would imagine the Pharmacy of Cleveland Clinic Main Campus would qualify as being a Specialty Pharmacy.

    I still have many meetings to come with Financial Advocates, Social Workers and all the other key players that make up this gift of a second chance at life, where these topics will be discussed more deeply.

    Again everyone of you I have heard from in these forums have been so nice.

    Thank you!


  • les-viegas

    January 6, 2021 at 10:02 am


    I don’t believe that CC Pharma is available for an on-going supply of retail meds nor do I believe that it is a Specialty Pharma. You should check it out with CC. I doubt they are part of any PBM network and provide drugs primarily to CC inpatients just like other hospitals. In the past, CC has used Columbus Ohio based Avela Pharmacy to provide tx patients with the initial supply of meds and leave it up to the patients to decide where to get their meds from upon discharge. Avela is also a specialty pharma so you could consider them as your supplier for all your meds. Other options include Express Scripts, Walgreens both of which offer mail-order services.

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