Save Lives Now — Extend Kidney Anti-Rejection Drug Coverage
Posted Feb 22 2013 10:30am
(At the end of this blog you will find a sample letter and links to your congressional and senate representatives.)
If someone told you that your government was willing to spend about $650,000 to save from $17,000 to $30,000 a year would you be surprised?
Well I’m the someone, and I’m telling you that what I have described is absolutely true. When your congress passed the End Stage Renal Disease (ESRD) law in 1972 then expanded Medicare to cover kidney transplants they bowed to pressure from the dialysis industry and limited anti-rejection medicine coverage to 36 months post-kidney transplant which resulted in the incredible expense I just described.
We can change that by putting some pressure on our elected officials to support a bill that ends this insanity. I’ll give details in a bit, but first some medical information.
The human immune system is a marvelous mechanism that immediately attacks any foreign body it detects with its full force and fury.
A transplanted organ is a foreign object so the immune system makes every attempt to destroy it, not knowing that destroying the organ will kill the human.
Enter anti-rejection drugs. These powerful, expensive drugs suppress the immune system so that a transplanted organ can not only survive but will extend the life of the recipient. The downside is that transplant patients are more susceptible to diseases because of their suppressed immune system. Without anti-rejection drugs, though, the immune system will win and the person will die.
The U.S. Congress knew that when they expanded Medicare coverage for kidney transplants. The law saved a lot of lives but it contains one very strange element. It only allows Medicare to pay for anti-rejection drugs for 36 months. After that the recipient is on the hook for from $17,000 to around $30,000 a year these very special drugs. Many patients have found that at the end of the 36 month period they simply couldn’t afford the expense and either cut back on the medication or quit taking it and went into rejection
Strangely, if the patient seeks medical help to stop the rejection, Medicare will leap back into action to rescue the patient that congressionally mandated policies put at risk and they will pay for hospitalization to stabilize the person and dialysis to keep them alive until they can get another Medicare paid transplant. So let’s do some math, ignoring the cost of the initial transplant and the anti-rejection drugs (about $300,000).
Stabilize patient in hospital (estimate)………………….$50,000
Dialysis during 3-5 year wait for kidney…$216,000 to $360,000
Second transplant ………………………………………..$262,000
One patient gets two transplants meaning it’s entirely possible that another patient won’t get one. Cost…incalculable.
Total: About $600,000 spent to save the $17,000 to $30,000 cost of the initial anti-rejection drugs.
The last time this issue came before congress was in 2009 and opposition to expanding anti-rejection coverage came from a group calling itself the Kidney Care Partners coalition which said “the kidney care community strongly objects” to the proposed changes. Oddly one of the organizations opposing this move was The National Kidney Foundation which was joined by dialysis providers, drug companies and nephrologists.
To pay for the expanded coverage, House Democrats had proposed setting a flat fee for dialysis treatments and related medications that some providers say would not cover costs. The Congressional Budget Office has calculated that the package would save the government $100 million over the next 10 years.
Dialysis providers argue that the bundled-payment mechanism may force some clinics to close. “We believe that the amendment as proposed, while helping one group of patients, would potentially put another very vulnerable group of patients at risk,” said the letter from Kidney Care Partners, which was signed by its chairman, Kent J. Thiry, the chief executive of DaVita, a large commercial dialysis provider.
The group instead proposed to pay for expanded drug coverage by delaying when Medicare would start covering kidney patients who also have private insurance.
The National Kidney Foundation, the largest advocacy group for renal patients, says it signed on to the letter because it shares the group’s concerns about bundling of payments. But Ellie Schlam, the foundation’s spokeswoman, said its support for extending coverage for anti-rejection drugs would ultimately outweigh its opposition to
The American Society of Transplantation supports the provision. Currently there are over 100,000 Americans on the Kidney transplant waiting list a
The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act, currently in the U.S. Senate and House of Representatives, will extend Medicare coverage of anti-rejection drugs for the rest of the patient’s life. This will help patients to keep their kidney transplants, shorten the transplant waiting list, and lower Medicare costs.
Call for action
Please consider contacting your Senators and House Member. To determine your Senators and House Member, go to and input your zip code under Get Involved.
Dear Representative :
I am contacting you to request that you cosponsor important legislation for chronic kidney disease patients. H.R. 2969, the “Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2011,” was introduced by Representatives Burgess and Kind to help kidney transplant recipients obtain the life-saving immunosuppressive medications that are necessary to maintain the viability of their new kidney.
Individuals with chronic kidney failure require kidney dialysis or a transplant to survive, and are eligible for Medicare regardless of age or other disability. There is no time limit on Medicare coverage for dialysis patients. However, transplant recipients who are not aged or disabled retain Medicare eligibility only for 36 months following their transplant. After their Medicare ends, they often face the challenge of obtaining group health insurance or other coverage, greatly increasing the risk of organ rejection if they cannot afford their required medications. If the transplanted kidney fails, they return to dialysis or receive another transplant, both of which are more costly (Medicare spends more than $77,000 annually on a dialysis patient and about $19,100 per year for a kidney transplant recipient, after the year of the transplant).
H.R. 2969 would extend Medicare Part B eligibility, and only for immunosuppressive medications. Coverage for any other health needs would end 36 months after the transplant, as under current law. The legislation also requires group health plans to maintain coverage of immunosuppressive drugs if they presently include such a benefit in their coverage. Lifetime immunosuppressive coverage will improve long term transplant outcomes, enable more kidney patients who lack adequate insurance to consider transplantation, and reduce the number of kidney patients who require another transplant. Nobody should lose a transplant because they are not able to pay for the drugs to maintain it. On behalf of thousands of transplant recipients, I respectfully request your support of this legislation.
In order to help you write to your representative in congress Bob’s Newheart has provided the following resource.
Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 2,500 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.
You may comment in the space provided or email your thoughts to me at email@example.com. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.
Please view our video “Thank You From the Bottom of my Donor’s heart” on http://www.organti.org This video was produced to promote organ donation so it is free and no permission is needed for its use.
If you want to spread the word personally about organ donation, we have another PowerPoint slide show for your use free and without permission. Just go to http://www.organti.org and click on “Life Pass It On” on the left side of the screen and then just follow the directions. This is NOT a stand-alone show; it needs a presenter but is professionally produced and factually sound. If you decide to use the show I will send you a free copy of my e-book, “How to Get a Standing “O” that will help you with presentation skills. Just write to firstname.lastname@example.org and usually you will get a copy the same day.
Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative The more members we get the greater our clout with decision makers.
Bob Aronson Newheart de Bob es un receptor de trasplante cardiaco 2007, el fundador de Facebook, casi 2.500 Iniciativa miembro de Trasplante de Órganos y el autor de la mayoría de los blogs de donación / trasplante.
Puede comentar en el espacio proporcionado o por correo electrónico sus pensamientos a mí en email@example.com.Y – por favor, difundir la palabra acerca de la necesidad inmediata de más donantes de órganos.No hay nada que puedas hacer lo que es de mayor importancia.Si usted convence a una persona de ser donante de órganos y tejidos puede salvar o afectar positivamente a más de 60 vidas.Algunas de esas vidas pueden ser personas que conoces y amas.
Por favor vea nuestro video “Gracias desde el fondo de mi corazón Donante” en http://www.organti.org Este video fue producido para promover la donación de órganos por lo que es libre y no se necesita permiso para su uso.
Si quieres correr la voz acerca de la donación de órganos personalmente, tenemos otra presentación de PowerPoint para su uso libre y sin permiso.Sólo tienes que ir a http://www.organti.org y haga clic en “Life Pass It On” en el lado izquierdo de la pantalla y luego sólo tienes que seguir las instrucciones.Esto no es un espectáculo independiente, sino que necesita un presentador pero es profesionalmente producida y sonido hechos.Si usted decide usar el programa le enviaré una copia gratuita de mi libro electrónico, “Cómo obtener un pie” O “que le ayudará con habilidades de presentación.Sólo tiene que escribir a firstname.lastname@example.org y por lo general usted recibirá una copia del mismo día.
Además … hay más información sobre este sitio de blogs sobre otros donación / trasplante temas.Además nos encantaría que te unas a nuestro grupo de Facebook, la Iniciativa de Trasplante de Órganos Cuantos más miembros que obtenemos mayor será nuestra influencia con los tomadores de decisiones.