Extending Medicare’s coverage of immunosuppressive drugs has been one of the National Kidney Foundation’s top legislative priorities for many years. The question is: are we getting closer to passage?
The answer is “yes!” NKF continues to be very encouraged about the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2013 (H.R. 1428 and S. 323).
NKF has had frequent contact with the sponsors of this legislation to develop strategies to increase support and move the bill forward, and submitted written testimony, highlighting the importance of this legislation, that was included in the June 28 hearing in the House Energy and Commerce Health Subcommittee.
Momentum continues to grow, thanks to the hard work of our advocates around the country who have been sending emails, calling and visiting with their Members of Congress to let them know how this important legislation would impact them.
A July 2013 report issued by the Congressional Research Service (CRS) on Medicare coverage of immunosuppressive drugs for kidney transplant recipients contained information that we believe will be very helpful in building the case for an extended Medicare benefit.
The CRS report noted that in 2010, Medicare spent nearly $33 billion on ESRD-related services, yet the portion of this for immunosuppressive drugs was only $345 million. In that same year, Medicare spent $4,008 per transplant recipient for immunosuppressive drugs under Part B. Without any doubt, Medicare’s cost for these medications (and for kidney transplantation in general) is a fraction of the cost of annual dialysis.
CRS also noted that since 2009, the average cost of the most commonly used immuno meds under the program has decreased by more than 50%, mostly due to increased use of generic medications. We are confident that the declining cost of the drugs, coupled with the fact that many currently uninsured transplant recipients will be able to purchase insurance under the Affordable Care Act (ACA), will make H.R. 1428 / S. 323 very cost effective and increases the possibility of congressional approval. The CRS study reviewed preliminary information on the ACA’s essential health benefits (EHB) benchmark plan in multiple states, and found that the plans will typically require health plans to cover these immuno drugs. Thus, since more people will have insurance coverage, fewer will need the extended Medicare benefit, lowering the cost of H.R. 1428 / S. 323.
What can you do?
Continue to communicate with your Members of Congress! If they are a cosponsor, please thank them. If they have not yet signed on as a cosponsor, ask that they do so. Be sure to tell them what this legislation would mean for you and other kidney transplant recipients. Take Action today! Together, we can make sure that life-saving immuno drugs are available for all kidney transplant recipients.
Advocacy in Action 
This issue has intrigued me since I found I was in ESRD. It is personal since my transplant last year. It makes no sense to stop paying for medication that will preserve a kidney. Failure of that kidney will force the person back on dialysis which is much more expensive. Why?
Do you know that there are other transplants beside kidney? For example, heart, lungs, liver, & pancreas. These people are important too and comprise 50% of the total number of all transplants.
Why can’t you include them??
Donald Ehnot
Hi Donald,
This specific legislation eliminates the 36 month limit for kidney recipients under age 65 who already qualify for Medicare due to their end stage kidney failure. Other solid organ recipients qualify for Medicare only if they are aged or receive Social Security Disability, whereas kidney failure patients are eligible for Medicare regardless of age. Many recipients of other organs will be eligible for health coverage under the ACA beginning in January.
Erin Kahle
Constituent Services Director
National Kidney Foundation
Thanks for your answer. What is ACA? But please do not forget us.
Don
ACA is the Affordable Care Act.
I’m not sure what states under the ACA will require insurance plans to cover immunosuppressant drugs. Therefore I would rather see Medicare extend their coverage for these drugs for the life of the transplanted kidney and not just 36-months from the date of transplant. I intend to continue contacting my Senators and Congressman asking for their support for the bills currently in the house and senate that would extend Medicare coverage for immunosuppressant drugs for the life of the transplanted kidney.
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