Does Medicare Cover Cellcept?

In this article...
  • Cellcept, a prescription drug used to prevent organ rejection following a transplant, may be covered by Medicare. Learn about the potential costs of Cellcept.

For people who have had an organ transplant, Cellcept works by preventing the immune system from rejecting the transplanted organ. According to GoodRx.com, Cellcept isn't typically covered by Medicare prescription drug plans. Some Medicare plans may cover Cellcept, which is a brand-name drug, if it's medically necessary. The generic alternative to Cellcept, mycophenolate, is covered by 100% of Medicare drug plans

Drug Information for Cellcept

Cellcept is an immunosuppressive drug given to individuals who have had a heart, kidney or liver transplant. It prevents the body's immune system from attacking the new organ to reduce the chance of organ rejection. There are serious risks with taking this drug, including increased risk of infection, which should be discussed thoroughly with the prescriber. 

Cellcept may cause drowsiness, confusion, dizziness and shaking, so you shouldn't drive or operate heavy machinery until you know how the medication affects you. Due to increased infection risk, you shouldn't have vaccinations while taking Cellcept. Serious side effects that require immediate medical attention include chest pain, rash, difficulty breathing and fever. 

How Much Does Cellcept Cost With Medicare? 

Cellcept isn't typically covered by Medicare unless medically necessary. Your doctor will need to submit a request to your Medicare plan asking for Cellcept coverage. If you're approved for coverage, you'll pay higher out-of-pocket costs for Cellcept that are comparable to drugs on Tier 4 or Tier 5 of your drug plan; costs may exceed $1,200 for a 30-day supply. 

The generic alternative, mycophenolate, is less expensive than Cellcept and usually offered on Tier 2 of Medicare prescription drug plans. Average co-pays for mycophenolate range from $0 to $20. Some Medicare beneficiaries may qualify for Extra Help with prescription drug costs or Medicaid, which could result in zero out-of-pocket costs for the generic version of Cellcept. 

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