Will Congress finally extend immunosuppressive drug coverage for kidney transplant recipients?

Update March 12, 2020: H.R. 5534 passed unanimously in the House Energy and Commerce Health Subcommittee on March 11, clearing an important legislative first step. Also, the Senate introduced its version of the legislation, S.3353, on February 27. Contact your representative and senators and urge them to cosponsor these bills.

Robert Ostrom struggled with kidney problems in his childhood due to a genetic defect that left him with one functioning kidney. By his early 20s his kidney was failing, and he went on dialysis. Robert was placed on the transplant list and received a kidney when he was 27 years old from a deceased donor.

The new kidney was life changing for Robert. With the vast improvement in his health, he went back to school to prepare himself for a new career in the computer/IT industry, and Robert and his wife bought a house and had children.

However, because Robert was under 65 years old, his Medicare coverage ended three years after receiving his transplant. Once that coverage ended, Robert struggled financially to afford the immunosuppressive drugs that a kidney recipient needs to take for the life of their transplant to prevent organ rejection. Robert tried everything he could to pay for his immunosuppressive drugs and pay his family’s bills, including spending savings and retirement funds and borrowing money from family. But eventually he stopped taking the immunosuppressive drugs because he could no longer afford them.  His transplanted kidney failed and he went back on dialysis.

Robert’s health declined in the ensuing years, and in the last year of his life he battled pneumonia, infections and cardiovascular problems. He died on August 10, 2015 at the age of 46.

In Congress, legislation has been introduced in the House of Representatives that would ensure access to immunosuppressive drugs that kidney transplant patients need to prevent their new kidney from being rejected. The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019 (H.R. 5534) would extend Medicare coverage for immunosuppressive drugs by removing the current three-year limit for transplant recipients under the age of 65 and who are Medicare-eligible because of their end stage renal disease (ESRD). The Senate is expected to introduce their version of the legislation soon.

For most people with ESRD, a kidney transplant is the best and most desired treatment. Extended Medicare coverage of immunosuppressive drugs will help kidney recipients avoid situations where they struggle to pay for their needed medications and other necessities and must make tough decisions that can lead to the loss of their donated kidney. Additionally, recent estimates from the U.S. Department of Health and Human Services show that extending coverage of immunosuppressive drugs would result in significant savings to the Medicare program.   

“I hope Congress passes this bill,” says Marylynn Saunders, Robert’s mother. “It just makes sense, and it can save lives.”

Take action: Urge your U.S. Representatives to cosponsor immunosuppressive drug legislation

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About the Author

Mike Ly

Mike Ly is Director Of Public Policy at the American Kidney Fund

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