Coverage currently ends at 36 months despite need to take immunosuppressant medication for life
Congressman Brian Higgins, D-NY-26, is pushing for approval of new legislation that would expand coverage, under Medicare, of the prescription drugs patients are required to take to reduce the risk of rejection following a kidney transplant.
“Under this legislation, we have an opportunity to save health care costs to the consumer and to the government while saving lives,” Higgins said. “This is a policy change that is simply common sense and it is one that gives those struggling with kidney disease, and the families who choose donation, the best opportunity to see successful long-term outcomes.”
According to the Centers for Disease Control and Prevention, 37 million people (approximately 15% of U.S. adults) have chronic kidney disease (CKD). Those who have conditions that deteriorate to a point where dialysis or a kidney transplant is necessary are considered to have end-stage kidney disease (ESKD).
Most patients with ESKD are eligible for Medicare regardless of their age. If one is the recipient of a kidney transplant, their immunosuppressant drug coverage lasts for a period of just 36 months. At that point, patients without adequate prescription drug coverage have been known to ration or forgo their medications altogether, risking rejection of the transplanted kidney and a return to dialysis. Others on dialysis choose not to get a transplant, because they know they won’t be able to afford the medications necessary afterward.
The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act (H.R. 5534) would extend Medicare coverage to transplant patients beyond the 36-month current standard only for immunosuppressive drugs and only if the individual does not have public or private insurance. The bipartisan bill, introduced by Rep. Ron Kind (D-WI) and Rep. Michael Burgess, M.D. (R-TX), and cosponsored by Higgins, was referred to the Energy and Commerce Committee as well as the Ways and Means Committee, on which Higgins serves.
“Since 2000, over 1,900 lifesaving kidney transplants have been performed at ECMC,” said Thomas J. Quatroche Jr. Ph.D., president and CEO at ECMC. “More than 113,000 Americans are currently awaiting a lifesaving organ transplant and more than 8,000 New York state residents are on the waiting list for a kidney transplant. The Regional Center of Excellence for Transplantation and Kidney Care plays a significant role in improving our patients’ quality of life and has the lowest transplant wait times in the country. So, this critically important legislation co-sponsored by Congressman Higgins will further improve these patients’ lives and ensure that they receive the adequate prescription drug coverage they need and deserve. We thank Congressman Higgins for always advocating for our ECMC patients and our community.”
“This bill is critically needed since it will assure kidney transplant recipients will receive transplant medicines to keep their kidneys as long as possible,” said Dr. Liise Kayler, program director of the Regional Transplantation and Kidney Care Center of Excellence at ECMC. “We are grateful to Congressman Higgins for his co-sponsorship of this important federal legislation.”
“No one should lose a transplanted kidney because he or she can’t afford immunosuppressive medication,” said Jeremy Morlock, director of the Kidney Foundation of Western New York. “Extending Medicare Part B coverage for transplant recipients in need will save lives in our community. It will protect the ‘Gift of Life’ that has been given by organ donors.”
According to a report issued by the U.S. Department of Health & Human Services, extended immunosuppressive drug coverage would actually save as much as $300 million over 10 years. The cost of anti-rejection drugs averages less than $2,400 per patient annually, while the cost to Medicare for a patient on dialysis runs upward of $90,000 each year.
The CDC reports more than 726,000 people in the U.S. are currently on dialysis or living with a kidney transplant.