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Why Limiting Anti-Rejection Coverage Costs Transplant Patients More Than Money

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Kevin Longino

CEO, National Kidney Foundation

For the 726,000 Americans with irreversible kidney failure, getting a kidney transplant offers the best chance at living a long, healthy life. A successful transplant means freedom from dialysis and an opportunity for a normal, productive, and fulfilling future.

Although transplantation is the best therapy for kidney failure, there are nearly 100,000 patients currently on the kidney transplant waitlist — and only about 21,000 transplants are performed each year.

Once a patient is finally fortunate enough to receive a kidney, they are required to take daily immunosuppressive (anti-rejection) drugs for the life of the transplant, or they will lose the same kidney they likely waited and hoped for over many years.

The costs for these immunosuppressive drugs can be too high — as much as $10,000 or more every year — for patients without access to adequate health insurance. In this case, the solution seems simple: Giving kidney transplant patients lifetime insurance coverage for immunosuppressive drugs will save lives.

Fixing a gap in coverage

Patients with irreversible kidney disease are eligible for Medicare regardless of age, but Medicare beneficiaries who are non-aged or non-disabled lose that coverage 36 months after a transplant. After that time expires, many patients cannot afford the immunosuppressive drugs they need.

The costs can be so prohibitive that patients skip doses and risk organ rejection, resulting in Medicare having to pay for a new round of dialysis. Given this is a known problem, many dialysis patients don’t seek a transplant at all, because they know they will not be able to buy the medications.

recent report from the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation demonstrates that extending Medicare coverage of immunosuppressive drugs for patients beyond the current limit not only saves lives but saves money. The report shows that extending the coverage would result in an accumulated savings of approximately $73 million over 10 years. In other words, this is essentially a no-cost program that is just common sense to support.
Today, Medicare pays for dialysis indefinitely. It also pays for a kidney per transplant (at more than $131,000) and for the drugs necessary to reduce the likelihood of organ rejection. Yet, after just a few years, that drug coverage disappears. Many patients, donors, advocates, and others in the kidney community agree that’s too high of a price to pay — in lives.

Kevin Longino, CEO, National Kidney Foundation, [email protected]

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