From the NKF:
A recent Avalere Health shows how some
Exchange/Marketplace plans are shifting costs of immunosuppressive drugs to
patients calling into question how those under age 65 whose Medicare coverage
ends 36 months post-transplant will be able to afford their meds.
Paying Through the Nose to Keep a Kidney
Research from NKF on
drug coverage in 2015 healthcare exchange plans found that plans are charging
high cost-sharing for immunosuppressive medications, requiring patients to pay
an average of 36 percent of the cost for transplant medications. The data
analysis was conducted by Avalere.[1] These higher rates are an indication that
healthcare exchange plans are shifting immunosuppressive drug costs to
patients. These medications are necessary for patients to prevent transplant
rejection.
At the same time, recent
data (.ppt) shared during last month’s Organ Procurement and Transplant
Network (OPTN) Advisory Committee meeting shows an increase in transplants
among younger adults from December 2014 to June 2015.
“We have to ask how
patients, especially young transplant recipients, are going to manage the
financial burden of maintaining their immunosuppression medications year after
year,” said Tonya Saffer, Senior Health Policy Director for the National Kidney
Foundation. “Financial burdens shouldn’t prevent someone from getting the medications
they need to keep the gift of life.”
Medicare coverage for
transplant patients expires 36 months post-transplant. The Affordable Care Act
(ACA) has offered broad access to insurance, giving transplant recipients who
are under age 65 and not disabled better options to gain insurance coverage
after Medicare ends. However, patient cost-sharing for immunosuppressive drugs
can be so high on the individual exchange plans that patients have difficulty
paying for their medications.
While most silver exchange
plans use flat copayments for generic immunosuppressive medication, for any
given drug 19-32% of exchange plans are using coinsurance. The average
amount of patient coinsurance across generic and brand immunosuppressive drugs
is 36% with three plans requiring coinsurance for immunosuppressive drugs up to
60%.
The use of coinsurance
typically results in patients paying more for their drugs. There is also a lack
of transparency for the dollar amount they will have to pay to fill their
prescriptions.
When coinsurance is
used, the average patient cost-sharing across all silver exchange plans is 36%
of immunosuppressive medications. The portion patients are being required to
pay can easily meet the annual out-of-pocket maximum which, in 2015, was $6,600
for patients not receiving a cost-sharing subsidy.
“We don’t want to
create a panic among transplant recipients, but we have to educate them and
make sure they have a financial plan for their medications,” said Matthew
Cooper, MD, Director of Kidney and Pancreas Transplantation at Medstar
Georgetown Transplant Institute. “We’ve also seen many patients being switched
to generic medications. While this may save money, we need to make sure
insurance plans and patients aren’t doing this without consulting their
transplant program. Sudden medication changes can affect the health of the
patient and the viability of their transplant.”
In 2016, plans will be
barred from placing nearly all immunosuppressive drugs on the highest
cost-sharing tier after a rule was made by the U.S. Department of Health and
Human Services. However, this action may not stop the trend of greater use of
coinsurance and higher copayments for organ recipients and others who rely on
medications to treat chronic conditions.
“These findings also
underscore NKF’s long-standing position on extending Medicare’s coverage of
immunosuppressive transplant medications,” Saffer said. “Providing coverage
will improve patient safety, decrease the chance of organ rejection, and reduce
the number of people who need to go back on dialysis if their transplants fail,
which is a costly proposition for our healthcare system.”
The National Kidney Foundation
is the leading organization in the U.S. dedicated to the awareness, prevention
and treatment of kidney disease. For more information, visit www.kidney.org.
[1] Avalere Health PlanScape®, a proprietary analysis of
exchange plan features. This analysis is based on data collected by Managed
Markets Insight & Technology, LLC.
Publication Date
Tuesday, December 15, 2015
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