Effective Jan. 1, Sensipar® (cinacalcet) will no longer be separately reimbursable under Medicare Part D for ESRD
The change described in this article affects members who are using the medication Sensipar® (cinacalcet) to treat an End Stage Renal Disease (ESRD) condition. Effective Jan. 1, 2018, the Centers for Medicare and Medicaid Services (CMS) has determined the drug Sensipar® will no longer be separately reimbursable under the Medicare Part D benefit when administered for hemodialysis. Instead, members with (ESRD) may be able to continue Sensipar® therapy from their dialysis center within the bundled hemodialysis payment.
Members who are receiving Sensipar® as part of their hemodialysis treatment should be referred to their nephrologist and/or dialysis center to discuss treatment options. If a member is not using Sensipar® to treat an ESRD condition, the coverage change with Sensipar® does not affect their approval; these members can continue receiving the drug at their pharmacy under their Part D coverage.
Please review the CMS guidance article, as soon as possible by clicking on the Medicare-Learning-Network-MLN Matters Article related to Sensipar®(cinacalcet).