Troubles Getting Sirolimus – Insurance Change

UPDATE: 12/17/24

I spoke with the pharmacy liaison, Suellen, from the transplant clinic. She said that Medicare is evaluating all of the paperwork that I had to determine if Medicare will pay for his anti-rejection medication. In the mean time, they will cover it. It needs to be filled by the pharmacy at UMASS. Luckily, they have their own delivery drivers so we don’t have to go and pick it up. He should have his Sirolimus tomorrow. They needed to order it.

In the event that Medicare won’t cover it, and Part D prescription plan won’t cover it, MassHealth should cover it with the rejection letters and a prior approval.

There’s a confusion on if it should be billed to Medicare Part B or Part D. I spoke with Sue, the insurance liaison at the transplant clinic. She said it’s suppose to go through Part B. She contacted the pharmacy. They will resubmit it to Dr. Verma’s office (Jill deals with this). Jill is aware and will try submitting it to Part B. It may need a prior approval. Sue will follow up with the pharmacy today.

I attached to following paperwork to a message to his transplant coordinator, Nicole.:

• The application for Medicare coverage, signed by the transplant nephrologist at UMASS just a day or two after his transplant.
• The letter I received in the mail for a phone appointment from Medicare for that application.
• The letter from Medicare dated almost a year an a half later stating that as of September 2000 (the month of his transplant) he was covered by Medicare.

NEVER, EVER THROW OUT THIS PAPERWORK!! I’ll be giving copies to Donna and Chad to keep for their records.