Working to Protect Transplant Recipients’ Immunosuppressive Drug Coverage

Nikia Okoye  |  Posted

A kidney transplant is a rare gift; there are nearly 100,000 people on the waiting list today, yet fewer than 16,000 kidney transplants were performed in the United States throughout all of last year. There simply aren’t enough organs available, and the wait for a transplant can be years long.

For those who are fortunate enough to receive a kidney transplant, it’s critical to do everything possible to reduce the risk of losing the organ. One of the most important things all organ transplant recipients must do is take immunosuppressive medications. These medications help to prevent the body’s immune system from rejecting the organ. Transplant recipients must take these medications for the life of the transplanted organ.

Some patients rely on Medicare Part D to cover the cost of immunosuppressive medications. A recent proposal by the Centers for Medicare and Medicaid Services (CMS) is putting Medicare Part D coverage for immunosuppressive medications at risk.

The American Kidney Fund is joining with many other patient organizations—representing patients who receive all types of organ transplants—in opposing this measure. We are asking our entire community of patients, loved ones and others who care about people with kidney disease to join with us so that our voice can be heard in Washington.

Some background: Immunosuppressive drugs are one of six “protected classes” of drugs under Medicare Part D. This means that Medicare Part D must cover all approved immunosuppressive drugs, giving transplant recipients access to the full range of available medications. On January 10, 2014, CMS proposed a change to Medicare Part D that would revise the criteria for these protected classes of drugs. Part D plans would no longer be required to cover all approved immunosuppressive medications—instead, Part D plans would only be required to cover each subclass of immunosuppressive medications.

By not covering all of the specific drugs within each subclass, this rule would put patients’ health at risk. Physicians prescribe these drugs in combinations that are carefully tailored to meet the needs of individual patients, making adjustments to reduce side effects and achieve immunosuppression. Every patient’s needs are different, and therefore, patients require access to the full range of approved medications. We are extremely concerned that this rule, if adopted, could jeopardize the health of transplant recipients who rely on Medicare Part D for their drug coverage.

We recognize the need to control spending in Washington, but this measure is not a responsible way for the nation to save on healthcare costs. Part D plans already have effective tools to manage costs in the six protected classes. And of course, patients who lose their transplanted kidneys must return to dialysis, which costs many times more than the medications and places patients at greater risk for repeat hospitalization and other increased costs of care.

On March 5, the American Kidney Fund will be holding our fifth annual Kidney Action Day on Capitol Hill. We look forward to bringing a wonderful group of patient-advocates to Washington for meetings with lawmakers on issues of importance to kidney patients. This issue will be high on our list of topics to discuss with Congressional offices.

But we want to do more. We have activated our online Action Center—a place where anyone in the United States can send a personalized message to their own representatives in Congress. It is critically important that we reach out to Congress on this issue over the next several weeks, because CMS will be making a final decision soon. I invite you to visit our Action Center today and send a message to your representatives on this issue that is of such great importance to the nation’s transplant recipients.

Nikia Okoye is Director of Government Relations for the American Kidney Fund

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