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.