NEJM article demonstrates shortsightedness of transplant coverage policy

Transplant experts have been advocating for an extension of Medicare immunosuppressive drug coverage for kidney transplant patients for a long time, yet the policy that ceases drug coverage for the majority of transplant recipients after three years remains in place. Despite overwhelming evidence that extending coverage would save lives, donated kidneys, and money, policymakers remain, according to a new perspective piece in The New England Journal of Medicine, penny wise and pound foolish. The failed bills that are introduced in Congress year after year are a sad side effect of the shortsightedness in our policymaking system.

The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2011 (H.R. 2969), currently before Congress, is a proposed amendment to the Social Security Act that would grant lifelong coverage for immunosuppressive medications to all kidney transplant recipients in the United States. As Congress seeks to slash spending, it is not necessarily popular to vote in favor of a bill that, on the surface, demands more money.

But extending coverage would, in fact, save money in the long run. “Premature transplant failure is the fifth leading cause of initiation of dialysis in the United States,” write the authors John S. Gill, MD, and Marcello Tonelli, MD. “Unfortunately, approximately 25% of patients whose transplants fail die within two years after returning to dialysis. This outcome is worse than the two-year mortality among patients with a functioning transplant from a deceased donor (6%) and still worse than that among age-matched dialysis patients who have never received a transplant (20%).”

The NEJM article notes that the intention of the coverage cut-off was to encourage transplant patients to go back to work and obtain private insurance. But although many patients go back to work, many have still not been able to obtain insurance that will cover the cost of the immunosuppressive drugs. This inevitably leads them back to organ failure, and likely a dialysis regimen that will leave them more dependent on government money.

"The lack of funding for essential immunosuppressants for many Medicare patients also contrasts sharply with Medicare's provision of funding for lifelong dialysis," the authors write. "Although it is a lifesaving treatment for kidney failure, dialysis produces poorer outcomes than transplantation and is far more expensive on a yearly basis than immunosuppressant regimens. Yet patients must revert to this more costly and less effective treatment when their renal allografts fail."

As Congress continues to look for ways to decrease spending, this bill is an example of what steps must be taken. The long-term effects of policy decisions need to be considered.

Providing lifelong coverage to all kidney recipients would save Medicare money, save donated kidneys, which are precious and rare gifts, and save lives.

Download a copy of the House bill.

There is also a petition to extend Medicare coverage for transplant patients. -by Rebecca Zumoff