Effective Jan. 1, Sensipar® (cinacalcet) No Longer 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 & 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 read the CMS guidance article related to Sensipar: Medicare-Learning-Network-MLN Matters.