New Data Shows Strong Need for Immunosuppressive Drug Coverage Legislation

About H.R. 2969/S.1454
Since 1973, Medicare has provided health coverage for all patients with kidney failure regardless of age through the Medicare end-stage renal disease (ESRD) program. This program covers dialysis services, transplantation, immunosuppressive drugs and other medically important services. But for those under 65, Medicare coverage ends 36-months after a kidney transplant. After that three-year period, many of these patients struggle to find coverage or to purchase the anti-rejection medications needed to maintain the transplant. As a result, patients often end-up back on dialysis sooner than they should, increasing both their time on dialysis as well as everyone’s wait for a transplant. Others don’t even apply for the transplant list as they know they can’t afford the drugs and continue on dialysis indefinitely.

Extending immunosuppressive drug coverage for the life of the transplant is both good public policy and fiscal policy, as the prospect of going back on dialysis is bad for both the patient and our health care system. Medicare currently spends approximately $77,500 per year on a dialysis patient, which does not have any time limitation. Medicare then incurs an average first year cost of more than $100,000 for renal transplantation and will pay for both dialysis and re-transplantation in the case of organ failure. Medicare only spends an average of $19,000 on a kidney transplant recipient per year after the transplant, approximately $58,500 less than pre-transplant dialysis patients.

The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2011 would eliminate the current time limitation and extend Medicare Part B coverage for kidney transplant recipients for the purpose of immunosuppressive drugs only. All other Medicare coverage would end 36 months after the transplant. For patients who have another form of health insurance, Medicare would be the secondary payer. Beneficiaries would be responsible for a premium amount to be determined by the Secretary of HHS, as well as applicable deductible and coinsurance requirements. The bill also amends the Employee Retirement Income Security Act of 1974 (ERISA) to require that group health plans currently providing coverage of immunosuppressive drugs for kidney transplant recipients maintain this coverage.