FRAA’s October 2017 Vendor Partner Spotlight: Amgen
On February 7, 2017 the FDA approved injectable Parsabiv, an equivalent to oral Sensipar for use in Hemodialysis patients. This medication will be commercially available for purchase in January of 2018. Effective January 1, 2018 injectable, intravenous and oral calcimimetics (Sensipar) will qualify for the Transitional Drug Add-On Payment Adjustment (TDAPA). This means the Dialysis provider will be responsible to bill these medications to Medicare Part B as an add on payment to the bundle base rate. There will be a transition for existing patients on oral Sensipar that do not transition to Parsabiv from their Medicare Part D plans to a Medicare Part B benefit billed by the Dialysis Provider under the TDAPA. For 2018 and beyond oral Sensipar will remain available for Hemodialysis patients not identified as candidates for injectable Parsabiv as well as PD and other home modalities where an injectable is not an option.
It is important for Dialysis providers to identify all patients taking oral Sensipar and their respective payer mix to determine who will be impacted by this change. For patients remaining on oral Sensipar the Dialysis provider will need to take appropriate steps to transition patients to a Specialty Pharmacy that is capable to meet logistical and pricing terms acceptable by Dialysis provider.
For additional information regarding the TDAPA see https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm10065.pdf
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