Friday, February 10, 2012

Insufficient Medicare Drug Coverage for Immunosuppression in Transplant Patients – The Chance to Right a Wrong

Current Medicare coverage for immunosuppressive drugs in transplant patients stops 3 years after kidney transplantation for all patients except those over the age of 65, or who have work related disabilities. This policy is based on the premise that once transplanted all patients should be able to join the work force and afford private insurance – therefore saving money for the healthcare system. Unfortunately this idea is wrong both financially and morally.

A recent publication in the New England Journal of Medicine by Gill and Tonelli highlights this problem beautifully. They point out that the U.S. is the only industrialized country that does not cover lifelong immunosuppression costs; and that long term transplant outcome in the United States is inferior to countries such as Australia, the UK and Canada that do provide lifelong coverage. In addition, an analysis of the USRDS registry revealed that Medicare insured patients have worse transplant outcome then non-Medicare insured patients, and that the discrepancy was amplified after 3 years post transplantation. Finally they point out that by improving transplant outcome by paying for lifelong immunosuppression, our healthcare system would actually save money, by virtue of having patients avoid more costly dialysis.

In addition we have all witnessed many transplant patients with complex medical problems, and significant chronic kidney disease that are unable to work. Not to mention that with the current unemployment rate even healthy people cannot find jobs!

There is currently a proposal before congress titled “The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2011,” that would reverse the prior provision and provide lifelong coverage for kidney transplant recipients. As nephrologists we should all rally behind this act, as we have all seen patients lose transplants due to the tremendous financial burden of immunosuppressive agents. Our participation is of utmost importance as a prior attempt at the same policy in 2009 failed.

So how can we help? The AST recently sent out an email that makes it pretty simple. I have attached the email below. Lets rally behind this act and set right a deadly policy that that has gone on for too long! Please comment on this post to show your support!

Please ask your:

2 Members of the U.S. Senate to Co-Sponsor:

S. 1454, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act

1 Member of the U.S. House of Representatives to Co-Sponsor:

H.R. 2969, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act

How Do I Do This?

1.) Call the U.S. Capitol Switchboard at (202) 224-3121;

2.) Ask to be transferred to the offices of your Members of Congress

(You have 3 of them);

3.) Once you are transferred, ask to speak with the Congressional office's Health Care Legislative Assistant;

4.) Request or leave a message indicating that as a transplant professional, from the Member's Congressional district or state, that you strongly urge the Member of Congress to co-sponsor House bill H.R. 2969 or Senate Bill S. 1454.

If you do not know the names of your 1 member of the U.S. House of Representatives or 2 U.S. Senators, you may go online to and there will be a site for you to enter your zip code and secure the names of your elected officials.


  1. I am not in favor of extending the medicare benefit for all patients Indefinitely.
    There has to be some rationing and coverage should be provided only for those who cannot afford these expensive drugs.

    1. My post-liver transplant immmune suppressants cost nearly 2000 U.S. dollars a month, I respectfully submit that very few American families can afford this. Are you suggesting that those who can't afford it, should simply die, for the financial good of all?

      I pray that you or your loved ones are never in this situation, but my guess is that anyone making such a statement as yours is likely among the small privileged group of persons who do not have to worry about such concerns....quite possibly do to inherited family money as opposed to your own hard work efforts.


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