Healio Special Report: Health Care and Politics

Healio Special Report: Health Care and Politics

December 10, 2020
2 min read

US House of Representatives approves bill offering lifetime transplant drug coverage

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Legislation that offers lifetime immunosuppressive drug coverage for Medicare patients who receive a kidney transplant regardless of age has passed the U.S. House of Representatives.

Patients diagnosed with end-stage kidney disease who are older than 65 years automatically receive lifetime immunosuppressive drug coverage if they received a kidney transplant. However, Medicare only offers coverage of the anti-rejection drugs for 3 years after transplant among patients younger than 65 years.

Source: Adobe Stock

H.R. 5534, the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019, would extend drug coverage to all patients with a kidney transplant, although those younger than 65 years would pay a monthly premium of $243 in the first year of the program. The premium would increase gradually to about $345 per month by 2030.

“With transplant patients suffering disproportionately from the adverse effects of COVID-19, this legislation is more critical now than ever,” the National Kidney Foundation said in a statement. “Patients must be reassured that they will have access to their life-saving immunosuppressive drugs and that they will not need to worry about skipping doses because they can’t afford the costs.”

If passed by the Senate and signed by the president, the benefit would begin in January 2023.

Michael C. Burgess

“Today is a monumental day for American kidney transplant patients,” U.S. Rep. Michael C. Burgess, MD, R-Texas, a member of the House Rules Committee and leader of the House Energy and Commerce Subcommittee on Health, said in a statement. “A new kidney gives hope of a better quality of life to patients, and by requiring Medicare to cover the critically needed immunosuppressive drugs past 36 months for certain kidney transplant patients, we will help protect that kidney and prevent a return to dialysis.

“This simple policy change is something I have championed for nearly a decade and one [that] kidney patients and their loved ones have been advocating for nearly [20] years.”

Both the CMS Office of the Actuary and the Office of the Assistant Secretary for Planning and Evaluation at HHS have published reports on the benefits of extending Medicare coverage of immunosuppressive drugs, which include financial savings for the Medicare program. A more recent analysis by the Congressional Budget Office estimates Medicare could save $400 million in the course of 10 years if lifetime immunosuppressive drug coverage were offered to all Medicare patients with a kidney transplant.

“The passage of this legislation today provides hope. I urge the Senate to quickly take this up and send it to the president’s desk,” Burgess said.

The bill has 67 co-sponsors in the House and 11 co-sponsors in the Senate.