For too many patients who receive a successful kidney transplant, that new gift of life could suddenly have an expiration date of just a few years. Whether a patient receives a kidney from a living or deceased donor, he or she still must take immunosuppressive, or anti-rejection, drugs indefinitely to keep the kidney working.
These drugs can cost an individual up to $10,000 a year, and the only way to afford them is good medical insurance. For most, that means Medicare, which only pays for the drugs for 36 months post-transplant. Once Medicare coverage for the immunosuppressive drugs expires, patients are faced with skyrocketing costs, and for some, it means choosing between these life-saving drugs and the necessary costs of everyday living, such as paying rent, food and transportation.
The drug costs are so high that patients risk organ rejection by skipping doses, only for Medicare to have to pay once again for the patient to return to dialysis. This cost dilemma also is why many dialysis patients don’t pursue a kidney transplant in the first place.
Right now, 726,000 people in the U.S. suffer from irreversible kidney failure, also called end-stage renal disease. Nearly 100,000 patients are on the kidney transplant waitlist and likely will be for about three to seven years. Only about 21,000 patients each year actually receive a transplant.
Most recently, Medicare spent a total of $35 billion in one year on individuals with kidney failure, including both dialysis and transplant patients. Medicare spends $3,379 per transplant patient on immunosuppressive drugs and about $93,000 for dialysis-related costs. A timely report released in May by the Centers for Medicare & Medicaid Services, Office of the Actuary, shows that extending Medicare coverage for the anti-rejection drugs beyond the current limit saves patients’ lives and money. The result would be a savings of $300 million over 10 years — so it only makes sense to fully support it.
Patients aren’t the only ones being cheated. Taxpayers are, too. Medicare pays for dialysis with no time limit and covers a single patient’s kidney transplant at more than $131,000. It only makes sense for Medicare to also cover the required immunosuppressive drugs for as long as the transplanted kidney lasts.
My life was saved 15 years ago from a deceased donor transplant, and every patient should have the same opportunity without the fear of an ominous three-year, monetary deadline looming that would cut off the very medications they need to keep their transplant working. We at the National Kidney Foundation have committed many years to fighting on Capitol Hill to change Medicare’s policy. We are grateful that, even prior to the report, U.S. Department of Health and Human Services Secretary Alex Azar agreed with us.
“Extending coverage of the immunosuppressant drugs could help patients avert dialysis in the future, supporting transplantation, which of course is a better health outcome at a lower cost,” Azar said.
We in the kidney community ask Congress to seriously consider what life is like for transplant patients — and to act by introducing legislation to extend Medicare coverage for immunosuppressive medications. Saving lives and saving taxpayer money is something we can all get behind.
This guest column has been updated.