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Important Notice for Medicare Beneficiaries with PI Receiving SCIG

September 5, 2018

Have you been hearing from your specialty pharmacy that they may not be able to cover your subcutaneous immunoglobulin replacement therapy (SCIG) as a Part B Medicare benefit?

If you are a Medicare beneficiary on subcutaneous immunoglobulin replacement therapy (SCIG) with a qualified primary immunodeficiency (PI) condition including Common Variable Immune Deficiency (CVID), Severe Combined Immune Deficiency (SCID) and X-linked Agammaglobulinemia (XLA), your treatment may be covered under Part B, also known as the medical coverage part of Medicare. A full list of covered diagnosis can be found here on pages 23-24.

Medicare Part B coverage for immunoglobulin (Ig) replacement therapy is important to the PI community because beneficiaries may purchase supplemental Medicare plans, also known as Medigap plans, to cover their Part B out-of-pocket costs. When Ig therapy is covered under Part D or the prescription drug part of Medicare, however, Medigap coverage does not apply, and beneficiaries will be required to pay the high coinsurance costs themselves. This could amount to thousands of dollars a month and result in individuals choosing to forgo treatment or having to switch treatment modalities and seek alternative sites of care from what their doctor had determined was best suited for their needs.

If you are a Medicare beneficiary with a covered PI condition and are being told you can only receive SCIG through Part D, make sure your Part B options have been reviewed and share you experience with us.

Also, we have heard from some people in our community that they have been asked by their specialty pharmacy to advocate to Congress and to the Centers for Medicare and Medicaid (CMS) regarding reimbursement for a services payment for Part B coverage for SCIG. Please know that IDF has been engaged in this issue and is supportive of providers being reimbursed for remote and in person services provided. As CMS works to determine the reimbursement policies and scope of coverage for home infusion services, however, we do not want to see Medicare beneficiaries with PI losing access to SCIG.

Please share with us if your specialty pharmacy has indicated that they will be unable to provide SCIG due to the new or anticipated Medicare rules regarding reimbursement for home infusion services and if they are seeking your advocacy support.

The information you share will help IDF effectively advocate for everyone in the PI community affected by these issues.

Click here to e-mail IDF, and we will reach out to you about your experience with your specialty pharmacy.

 

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