Expanding Medicare Coverage for Immunosuppressive Drugs Will Save Lives and Money

Emily Wood Transplant News

By TREC Staff

The recently introduced Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act (H.R. 5534) seeks to expand current Medicare coverage for the immunosuppressive drugs that allow transplant recipients to live. These drugs are currently covered for just 36 months post-transplant, despite the lifelong drug regimen required by transplant patients to prevent organ rejection and death.

The bill was introduced last year by Reps. Ron Kind (D-Wis.) and Michael Burgess (D-Texas), and has received support from transplant professionals, patient groups, and organizations including the National Kidney Foundation, the PKD Foundation, and Honor the Gift. Expanding coverage for these life-sustaining medications is the right thing to do for patients, and will also result in cost savings for taxpayers and the health system.

Immunosuppressant drugs are extremely expensive. Without health insurance, a typical kidney transplant patient could easily face monthly costs exceeding $1,000. For those with coverage, copays can sometimes still total hundreds of dollars. What happens after 36 months post-transplant when a patient cannot afford his or her medications? Too often the answer is that patients ration their medications or go without them all together, inevitably resulting in organ rejection, hospitalization, potential loss of the organ, re-listing for a new transplant, or even death.

This is unacceptable. Kidney transplant recipients need coverage of immunosuppressant drugs for life. Failing to provide Medicare assistance for those lacking private insurance means that kidney transplant patients who go into organ rejection may end up in the emergency room and back on dialysis. A good kidney is lost and the long line of patients on transplant waiting list gets even longer.

This current policy not only hurts patients but is also an ineffective use of Medicare funds. When a kidney transplant patient loses their organ and ends up back on dialysis, Medicare picks up the tab at a cost of nearly $90,000 per patient per year. [1] Currently there is no limit for dialysis reimbursement coverage. On the other hand, a kidney transplant has a one-time cost of $110,000 and an annual immunotherapy cost of $2,300 through Medicare Part B. [2]

According to the Office of the Assistant Secretary for Planning and Evaluation’s 2019 report, expanding Medicare’s coverage of immunosuppressant drugs for kidney transplant recipients would result in $73 million in accumulated savings over 10 years. Caring for dialysis patients is 3.5 times more expensive than caring for transplant patients, and they experience a lower quality of life and shorter lifespan. ESKD patients who receive a kidney transplant outlive their dialysis treated counterparts if they have access to life-prolonging immunosuppressant medications in order to decrease the likelihood of allograft rejection.

The current 36-month coverage policy lacks medical, ethical, and financial efficacy. Expanding coverage for life under the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act will save lives and help to ensure that precious organs are protected. Please join us in supporting this bipartisan legislation that will:

  • Allow kidney transplant recipients to continue to receive Medicare coverage for their immunosuppressant drugs
  • Improve ESKD patients’ quality and length of life
  • Save taxpayers and Medicare millions
  • Protect patients and their family and caregivers from financial ruin.

 

[1] JoNel, A. (2019, July 17). A ‘No-Brainer’? Calls Grow For Medicare To Cover Anti-Rejection Drugs After Kidney Transplant. Kaiser Health News. https://khn.org/news/kidney-transplant-anti-rejection-drugs-medicare-coverage/

[2] Cooper, M. (2020, January 8). Medicare policy on antirejection drugs imperils kidney transplants. STAT. https://www.statnews.com/2020/01/08/medicare-policy-antirejection-drugs-imperils-kidney-transplants/