Immunosuppression Timeline Information
your job and insurance, lose your kidney.
Links to Articles on this page
New York Times Article
March 13, 2009
Lifesaving Kidney Treatment, but Only to a Point
By DAVID TULLER
Margaret Oliver, a 47-year-old hairdresser in Venice, Calif., received a lifesaving kidney transplant in 2002. The government covered the costs under a special Medicare program for the hundreds of thousands of Americans with kidney failure who need either dialysis or a transplant.
Three years later, Medicare stopped paying for the expensive immunosuppressive
drugs that Ms. Oliver needed to minimize the risk that her body would reject
the organ. Because her kidney was functioning successfully at that point,
she was no longer considered to be suffering from end-stage disease and
so no longer qualified for the special coverage.
With the drugs costing about $800 a month, Ms. Oliver, who was self-employed, was able to buy them only sporadically, which endangered her transplanted organ. “It was horrifying," Ms. Oliver said. "I just didn’t know what to do."
Chronic kidney failure, also known as end-stage renal disease, is the only condition for which Medicare extends coverage to everyone, and not just to those who already qualify because of age or disability. The kidney program, mandated by Congress in 1973 after legislative hearings about the social and economic costs of dialysis and kidney failure, has been credited with greatly expanding access to treatment in subsequent decades.
program also covers 80 percent of the cost of immunosuppressive drugs,
but only for 36 months after a transplant
who do not otherwise
qualify for Medicare.
This week Senator Richard J. Durbin, Democrat of Illinois, and Senator Thad Cochran, Republican of Mississippi, introduced legislation that would require Medicare to cover the drugs for the life of the transplanted kidney. A similar bill introduced in the last Congress languished in committee.
This is one of the principal things we can do to help people keep the first
transplant they get,” said John Davis, chief executive
of the National Kidney Foundation.
For years, advocates for people with kidney failure have criticized the three-year limit as costly from a medical and economic perspective and as an unfair burden on patients with few resources. Although there are no exact numbers on how many patients have lost transplanted kidneys after Medicare coverage for their drugs lapsed, nephrologists and transplant surgeons routinely cite examples of such cases from their practices.
Ms. Oliver, the hairdresser, was unable to get prescription drug coverage under the recently established Medicare Part D program, since Part D does not cover those who are only in Medicare because of end-stage renal disease. She finally managed to obtain coverage through a state-sponsored program for high-risk individuals. But the many months of interrupted treatment significantly weakened her new kidney and increased the chances that she will lose it in the near future, said Dr. Stanley C. Jordan, Ms. Oliver’s surgeon and the medical director of the kidney transplant program at Cedars-Sinai Medical Center in Los Angeles.
“ So far she is doing okay, but she will likely return to dialysis at some point in the next one to two years,” Dr. Jordan wrote in an e-mail message.
Transplantation is recommended people with advanced kidney failure who are healthy enough to undergo the surgery. It generally provides better long-term outcomes and a higher quality-of-life than dialysis, which can be a grueling regimen and take a serious toll on other organ systems in the body. Many patients must remain on dialysis for years while they await a suitable organ for donation.
experts say some patients choose not to get transplants because they
are worried about not
being able to
afford the immunosuppressive
in the future. Because of the drug coverage
limit, transplant centers also must consider patients’ ability
to sustain a long-term medication regimen when
deciding whether to accept
Patients need to take the drugs for as long as they have the transplanted kidney. While many organ recipients are able to obtain health insurance through employers or spouses, others, like Ms. Oliver, find themselves with few options in the private insurance marketplace. If they lose the kidney, they have to return to dialysis — which Medicare will cover — and return to the organ waiting list.
Moreover, there is no guarantee that a second matching kidney will be found for them or, if one is, that they will still be healthy enough to receive another transplant.
Medicare spends on average $17,000 a year for the immunosuppressive drugs for a kidney transplant recipient, compared to about $70,000 for a year of dialysis, according to the National Kidney Foundation. A transplant costs more than $100,000.
“ Kidney transplantation is cost-effective versus dialysis, and the government has to pay for one or the other,” said Dr. Mark D. Stegall, surgical director of the Mayo Clinic’s kidney transplant program. “Most transplant programs try their best to help the patients, but I think there are centers that turn people down or strongly discourage people from getting transplanted if they don’t have coverage.”Copyright 2009 The New York Times Company