The American Society of Transplantation would like to call your attention to a critical problem with immunosuppressant drug coverage for kidney transplant recipients under the Medicare Part B benefit:
Immunosuppressant Drug Coverage under Medicare1
The Importance of Immunosuppression
Organ transplant recipients must take immunosuppressive medications for the lifetime of their transplanted organ. Similar to many chronic diseases, the need for medical therapy goes on indefinitely. If immunosuppressive medications are discontinued, rejection and loss of the transplanted organ are almost certain to occur.
If a kidney transplant recipient’s kidney fails, a return to dialysis sessions is necessary. Dialysis is linked with a lower quality of life and increased mortality compared with kidney transplantation. The cost of dialysis is far above and beyond the cost of immunosuppressive medications for the same time period. Additionally, respect for the organ donor requires that a means of maintaining that organ is available. It is cost-effective, important for the recipient, and respectful of the donor’s gift to provide lifetime immunosuppression.
Consequences of the 36-Month Medicare Termination for Kidney Recipients
Without insurance coverage, most patients have no recourse due to the inability to pay for these costly medications. Evidence has demonstrated that:
How Can We Solve This?
The American Society of Transplantation (AST) has worked tirelessly with Congress to meet the goal of extending coverage of immunosuppressive medications beyond the current 36-month limitation set by Medicare for kidney transplant recipients. A bill proposing lifelong immunosuppression drug coverage has been introduced in Congress many times since the year 2000. The only way to maintain transplant function and the life of the recipient is to provide lifetime drug coverage for the transplant recipient.
The AST supports initiatives that ensure the coverage of immunosuppressive medications for the lifetime of all transplanted organs, regardless of age and ability to pay. Ultimately, this will lead to improved transplant success rates, the greater ability of transplant recipients to return to a normal life, and greater availability of organs for those in need.
1 www.medicare.gov/coverage/prescription-drugs-outpatient.html
2 Evans RW, et al. Clin J Am Soc Nephrol 2010; 5: 2323-8.
3 Gill JS, et al. N Engl J Med 2012; 366: 586-9.
Approved by the AST Board of Directors on March 2-3, 2009
Revised and approved by the AST Board of Directors, September 6, 2011
Revised and approved by the AST Board of Directors, August 12, 2015
Revised and approved by the AST Board of Directors, December 11, 2019