Effective January 1, 2018 Sensipar (cinacalcet) will have a new B vs D determination requirement for Medicare Covered Persons who have a diagnosis of end-stage renal disease (ESRD) and are on dialysis. CMS requires this new process to assess for the appropriate payer under Medicare Part D or the bundled payment to the ESRD Facility.

Action Required

If Participating Pharmacies receive a prescription for Sensipar or for cincacaclet for a Medicare Part D Covered Person who has a diagnosis of ESRD with dialysis on record with CMS, the claim will reject even if there is a current prior authorization on file. If a prescription for Sensipar or cincacaclet is submitted, the claim will reject at point-of-sale (POS) with the following reject message:

*Please see attached for more information.