Transitioning from Part D to Part B: A Medicare Story

Author: Jeffrey L. Hymes, MD, CMO & SVP

Following the U.S. Food and Drug Administration’s recent approval of Parsabiv™ (etelcalcetide), an IV formulation equivalent to the oral calcimimetic Sensipar® (cinacalcet), dialysis providers like Fresenius Kidney Care have been diligently preparing for a new fulfillment process for Sensipar. Under the Medicare End Stage Renal Disease (ESRD) prospective payment system (the “Bundle”), when an IV formulation of an oral-only drug used for the treatment of ESRD becomes available, both formulations become reimbursable under Medicare Part B. The reclassification of Sensipar by the Centers for Medicare and Medicaid (CMS) under the ESRD payment system is effective January 1, 2018. CMS will evaluate the utilization of both formulations during a two-year transition period then adjust the base rate of the Bundle, accordingly.

While patients are accustomed to the traditional prescription fulfillment process under Medicare Part D whereby a physician provides a patient with a prescription to be fulfilled at the pharmacy of the patient’s choice, patients may not be as familiar with the Part B process. For patients with Medicare Part B primary benefits, this means that their dialysis provider will be responsible for providing Sensipar via a pharmacy of the provider’s choice after January 1st.

To ensure compliance with therapy and to better support our patients, Fresenius Kidney Care has chosen FreseniusRx to provide Sensipar to its Medicare Part B patients after January 1st. FreseniusRx pharmacists are trained in renal disease and specialize in renal medication. The transition of Sensipar from Part D to Part B provides FMCNA an opportunity to further integrate pharmacists into the care of our patients under a value-based care model.

Navigating a new fulfillment process for the drug may cause some patients confusion. You can help your patients by ensuring they understand the change in how Part B medications are provided and paid for and why CMS bundles certain medication with treatment for better integrated care.

About the Author

Jeffrey L. Hymes, M.D., is Chief Medical Officer and Senior Vice President of Fresenius Kidney Care and Chairman of the Pharmacy and Therapeutics Committee. Dr. Hymes served as President of Nephrology Associates in Nashville, TN, and as President and CMO of National Nephrology Associates. He is a former member of the Renal Physicians Association Board of Directors, and is board certified in Internal medicine, Nephrology and Critical Care.