Bill challenges Medicare limit on meds for kidney recipients

This week, two Senators introduced a bill that would require Medicare to cover high-ticket drugs used to support kidney transplant patients for the life of the transplanted kidney. The bill would greatly extend CMS's existing policy, which is considerably tougher.

Since 1973, Medicare has covered treatment for any citizen with end-stage renal disease, and 80 percent the bill for costly immunosuppressive medications. However, CMS limits reimbursement for medications to three years if the patient wouldn't otherwise qualify for Medicare. Advocates and physicians are telling lawmakers that patients are losing transplanted kidneys after Medicare coverage for their drugs lapses.

Critics of the existing policy say that it's not only cruel, but needlessly expensive as well. While Medicare pays an average $17,000 a year for the kidney transplant drugs, it would pay about $70,000 a year for dialysis, to which patients must return if their transplant fails, they note.

The new bill also strikes at a troubling problem that advocates say is real, if difficult to document. Right now, some patients with limited coverage say that transplant centers have all but refused to give them a new kidney, fearing that the patient would lose it quickly. Lifetime drug coverage could change this equation, they suggest.

To find out more about the bill:
- read this piece from The New York Times

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.