WE
NEED A NEW MEDICARE POLICY ON IMMUNOSUPPRESSANT MEDICATIONS FOR KIDNEY PATIENTS
Our Medicare policy on
anti-rejection medications is outdated and should be changed. Currently, for 36
months after transplant, Medicare picks up the high costs of immunosuppressant
medications. After that point, if you
are under the age of 65, you must either have independent/supplementary
insurance to pick up that coverage or you must pick up the expense out of
pocket. Since the costs for this
medication is extremely expensive, ranging in the thousands of dollars every
month, many people try to stretch their meds, not taking the prescribed dosage
or forgoing the medications altogether.
The result is that the patient may lose his/her new kidney and end up on
the only other renal replacement therapy, dialysis. That patient may also die.
According to a December 6th,
2017 article in the Washington Post,
“Kidney
transplants are universally acknowledged as the best treatment for kidney
failure. Compared with remaining on dialysis, transplant recipients live longer, have better quality of life, are more
likely to raise a family, have fewer symptoms and incur far fewer health-care
costs.
After a
successful transplant, keeping the kidney functional requires lifelong use of
immunosuppressive medications, which prevent the recipient's body from
rejecting the new organ. These medications provide excellent value for money
since they allow the patient and society to reap the benefits of kidney
transplantation.
As researchers from Canada, we've
studied health care for those affected by kidney disease in the United States
and other developed nations. Since 1972, Medicare has provided coverage to
patients with kidney failure, regardless of age or disability status. However,
while there is no time limit for dialysis patients, kidney transplant
recipients who are not otherwise eligible for Medicare lose their coverage 36 months after
they receive their transplant — leaving many unable to pay for
immunosuppressive medications. Without access to these medications, patients
eventually lose their transplants and require dialysis treatment instead.[i]”
There are some very good
reasons both economically and practically to change the Medicare coverage
policy to cover the costs of these meds for the life of the kidney transplant. Economically, the costs of covering the costs
of anti-rejection medications for life makes sense:
·
Kidney Disease is the 9th
leading killer in the US;
·
73 million 1 in 3 American adults is
currently at risk for developing kidney disease;
·
30 million 1 in 9 American adults is
estimated to have chronic kidney disease (CKD), although most don’t know;
·
Over 3 million (11%) of Medicare
beneficiaries have a diagnosis of CKD, but not kidney failure and many more are
estimated to have the disease, but are undiagnosed;
·
703,243 Americans have irreversible kidney
failure, or end-stage renal disease (ESRD), and require dialysis or a kidney
transplant to survive;
·
495,433 ESRD patients receive dialysis at
least 3 times per week to replace kidney function;
·
207,810 Americans live with a functioning
kidney transplant;
·
99,567 People with ESRD died in 2015;
·
19,848 Americans received a kidney
transplant in 2017;
·
95,466 Americans were on the
kidney transplant waiting list as of January 22, 2018;
·
71% of new ESRD patients apply for Medicare;
·
$98 billion Annual
Medicare costs to care for people with all stages of CKD, including kidney
failure;
·
$93,064 Annual Medicare spending on a
dialysis patient, per-year;
·
$36,389 Annual Medicare spending on a
transplant recipient;
·
$2,794 Medicare Part B spending on
immunosuppressive drugs, per year transplant patient[ii].
In other words, as a matter of costs alone,
it is much less expensive to keep people transplanted, then it is to put them
back on dialysis, which Medicare pays for the rest of the dialysis patients’
lives.
According
to the Post,
“Since 1972, Medicare has provided coverage to patients with
kidney failure, regardless of age or disability status. However, while there is
no time limit for dialysis patients, kidney transplant recipients who are not
otherwise eligible for Medicare lose their coverage 36 months after
they receive their transplant — leaving many unable to pay for
immunosuppressive medications. Without access to these medications, patients
eventually lose their transplants and require dialysis treatment instead.
This policy is irrational, since Medicare has already
paid for the kidney transplant and will pay to treat the patient with dialysis
— despite its markedly higher cost — when the transplanted kidney fails.
Our research has shown the United States stands alone in allowing this situation to exist.
All other wealthy nations recognize the benefits of immunosuppressive
medications and cover their costs for patients with functioning kidney
transplants.
Funding these medications would save hundreds of millions of
dollars annually in direct medical costs. Between 2008 and 2012, the most
recent data available, the average annual Medicare cost for a transplant
recipient was $22,000 compared with $47,000 for a dialysis patient. But those
costs are much higher — at $84,000 — for patients who suffered transplant
failure and had to return to dialysis. And if you look at only the patients who
died after a transplant failure, average costs skyrocket — to $201,000.[iii]”
There is also the humane, ethical,
practical issue that must be dealt with:
“Failing
to provide lifelong coverage also dishonors the gift of life made by thousands
of kidney donors each year, since denying such access means that some of these
gifts will be in vain. We estimate that in the past five years, 7,700 patients
have needlessly lost their kidney transplants, 900 patients have prematurely died,
and Medicare has squandered nearly $1 billion in health-care costs that could
have been averted if only funding for immunosuppressive medications had been
secured.
Even more
frustrating, a legislative remedy — commonly known as "the immunosuppression
bill" — is already available. Lawmakers first proposed the bill in 2011,
but it has repeatedly stalled.
This bill would allow Medicare-eligible kidney transplant
recipients to receive life-saving immunosuppressive medications for as long as
their transplant continues to function. Ironically, failure to pass this bill
into law during the Obama administration may in part be due to its bipartisan
support, which gave little political advantage to passing it.
It is impossible to justify continued inaction: The
problem and its solution are both straightforward. The machinery required to
fund, prescribe and deliver immunosuppressive medications is in place. All that
is needed is the political will to pass legislation and allow U.S. patients to
benefit.[iv]”
In other
words, people die because of losing their meds and subsequently their
transplanted kidneys and there is a remedy in place that common sense dictates
should pass the Congress and resolve the issue.
Most of the major kidney advocacy organizations I’m affiliated with have
given up temporarily on this legislation.
This vital issue to kidney patients remains unresolved.
[i] Our
Medicare policy for kidney transplants is totally irrational, Marcello Tonelli
John Gil, Washington Post, dated December 6, 2017.
[ii]Figures
are from the National Kidney Foundation, Overview of the Kidney Disease
Population, https://www.kidney.org/news/newsroom/factsheets/CKD-A-Growing-Problem,
Feb 2018. Their sources include: United
States Renal Data System, Centers for Disease Control and Prevention, National
Institute of Health, United Network of Organ Sharing and Organ Procurement and
Transplantation Network, CDC National Center for Health Statistics, Division of
Vital Statistics.
[iii] Our
Medicare policy for kidney transplants is totally irrational, Marcello Tonelli
John Gil, Washington Post, dated December 6, 2017.
