Take it from a kidney transplant recipient: Extending immunosuppressive drug coverage saves lives, money

Today in the United States some 726,000 of our neighbors are suffering from the effects of irreversible kidney failure, also known as end-stage renal disease (ESRD).

A majority of this population will receive dialysis treatment at least three times a week to survive. For others, this won’t be enough; nearly 100,000 Americans are waiting for kidney transplants nationwide.

{mosads}At one time, that was me. Thankfully, a transplant from a deceased donor in 2004 saved my life.

Of course, organ transplants are not cheap. While significantly more cost effective over time than dialysis, the cost of a kidney transplant patient to the government is more than $131,000 during the year of their transplant – a total that would be cost prohibitive for far too many of the patients I interact with today at the National Kidney Foundation, where I serve as CEO.

Since 1972, however, Medicare has helped these vulnerable Americans with ESRD expenses – regardless of age. The Medicare ESRD program is a vital resource for those facing the most aggressive forms of kidney disease; covering expenses related to dialysis and transplantation.

When kidney failure threatens to claim disease patients’ financial security and, worse, their very lives, this program offers protection. Now, Congress must ensure the ESRD program lives up to its fullest potential.

Kidney transplant recipients like me must take immunosuppressant drugs daily to ensure our bodies do not reject our transplanted organs. The Medicare ESRD program covers three years of this treatment, but then patients are left to their own devices.

I am fortunate to have affordable, private insurance coverage that gives me access to the medications I need to stay well but at the National Kidney Foundation we hear daily from patients with a very different story.

“I had to make the difficult decision to pause my status on the transplant list as I have no idea how I can continue to pay for those drugs essential to maintaining a transplant,” explained one of our patient advocates to me.

For some, this becomes a cruel series of events: they receive a new lease on life through coverage of an organ transplant, then find the rug pulled out from under them when coverage is halted for the very treatment they need to ensure the transplant does its job.

If a patient loses the kidney, as many have after falling victim to the ESRD program’s cutoff, they ironically find themselves back on Medicare funded dialysis. Medicare spends $3,379 per transplant patient annually on immunosuppressive drugs and roughly $90,000 per year for dialysis expenditures. This is shortchanging patients and taxpayers.

For patients who want back on the transplant waitlist, help comes too late for too many. Depending on where a patient lives, the average wait time for a kidney transplant can be upwards of three to seven years. Sadly, nearly 3,600 people died while on the waitlist in 2017 alone.

The despair of patients who thought they had left these painful realities behind, only to return to them later for financial reasons that we could prevent, is something that no one should have to endure.

We are not powerless to change this. In congresses past, bipartisan legislation was introduced to extend Medicare coverage for immunosuppressive treatments indefinitely, ensuring patients have unencumbered access to these lifesaving medications for the life of their transplant.

NKF led a strong advocacy effort to back these policies, but budgetary considerations made passage an uphill battle.

While one cannot put a price tag on human life, a new report from the U.S. Department of Health and Human Services (HHS) should remove any excuse for inaction.

The study found that extending immunosuppressant drug coverage would save $73 million over a decade, explaining that “If trends remain as they have, the annual savings to Medicare would continue to increase each year.”

Even before this report was released, HHS Secretary Alex Azar made the case for this needed policy fix, saying “Extending coverage of the immunosuppressant drugs could help patients avert dialysis in the future, supporting transplantation, which of course is a better health outcome at a lower cost.”

Health care matters in Washington can get complicated, but a solution that saves lives and saves money is just commonsense.

With these findings in hand, we at the National Kidney Foundation will redouble our work to ensure Congress follows Secretary Azar’s recommendations by extending Medicare coverage for immunosuppressive treatments.

Every day, another transplant recipient ages out of the ESRD program’s protections. Some will then choose between their medications and groceries or rent payments. Some will skip doses, while others will abandon their medication entirely – both risking greater possibility of organ rejection.

Those are painstakingly difficult decisions. The decision facing Congress is now, and the time to act is now.

Kevin Longino is the CEO of the National Kidney Foundation. Learn more at kidney.org.