Bob Aronson

Medicare Pays For Your Transplant But Not Anti-Rejection Drugs?

In Medicare on February 22, 2009 at 2:59 PM

.

According to the American Society of Transplantation (AST) “Organ transplant recipients expect to and must take immunosuppressive medications for the lifetime of their transplanted organ. Thus, organ transplantation should be viewed as a treatment rather than a cure. Similar to many chronic diseases, the need for medical therapy goes on indefinitely. If immunosuppressive medications are discontinued for any significant length of time, rejection of the transplanted organ is inevitable in all but a small minority of patients.”  http://www.a-s-t.org/index2.cfm?Section=public_policy&Sub1Section=key_position_statements&content=immunosuppressive_drug.cfm  (AST is an international organization of transplant professionals dedicated to advancing the field of transplantation through the promotion of research, education, advocacy, and organ donation to improve patient care www.a-s-t.org )

     

As I understand current law, Medicare will pay the cost of a transplant for eligible patients, they will even pay for a second transplant if necessary but they will only pay for expensive anti-rejection drugs for thirty six months.  There have been several attempts to change this situation but to date none have been successful.

 

In a special report on the issue of Medicare coverage of immunosuppressive drugs, AST also says,   

Extended coverage of immunosuppressive medications makes good fiscal sense, as well. Patients who stop their immunosuppressive medications run the risk of rejection of the transplanted organ. This usually leads to a prolonged hospitalization, at a cost of several thousand dollars a day. Thus, the amount of money necessary to cover the cost of immunosuppressive medications could be spent in a matter of days for one hospitalization related to rejection. If a kidney transplant recipient’s kidney fails, a return to thrice weekly dialysis sessions is necessary, at an expense above and beyond the cost of immunosuppressive medications for the same time period. Loss of other transplanted organs ultimately leads to death or the need for another organ transplant, at a cost of hundreds of thousands of dollars.”  The AST Executive Committee approved this report on April 26, 2006.  They summarize their position in the following manner:

·         Extension of coverage for immunosuppressive medications for the lifetime of the transplanted organ

·         Access to insurance coverage for the lifetime of the transplanted organ

“AST supports initiatives that ensure the coverage of immunosuppressive medications for the lifetime of a transplanted organ, regardless of age and ability to pay. Ultimately, this will lead to improved transplant success rates and the greater ability of transplant recipients to return to a normal life.”

.

Calling the current coverage policy “one of the great paradoxes in federal health policies,” US Representatives Dave Camp (R-MI) and Ron Kind (D-WI) introduced HR 3282 – the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2007 – despite their good intentions, however, the bill still has not passed congress. 

 

If the Medicare policy I have described is bothersome to you, then write to your members of congress, the U.S. Senate, The U.S. Department of Health and Human Services and President Obama.

 

Please comment in the space below or email your thoughts to  me at bob@baronson.org

 

Please read and comment on my World Wide Issues blogs on http://blogsbybob.wordpress.com.   Also…visit my Facebook site, Organ Transplant Patients, Friends and You at  http://tinyurl.com/225cfh  OR — my Facebook home page  http://www.facebook.com/home.php

About these ads
  1. [...] Medicare Pays For Your Transplant But Not Immunosuppressive Drugs … [...]

    Like this

  2. Very quietly, buried in a 3 page article on platelet rich plasma and horse and athlete injury treatments was this epic and monumental bombshell! Do NOT underestimate how significant this is. Up till this point, the US medical establishment thought that adult stem cells were unproven, of limited potential and a waste of time and money. Now the big daddy of them all, the NIH, is jumping in with both feet! This is not a secondary back up treatment to improve red blood cell levels after chemo. This is the NIH advocating THE USE OF ADULT STEM CELLS TO TREAT DEBILITATING MEDICAL CONDITIONS!

    You heard it here first! -DG

    “The National Institutes for Health seem to think regenerating human muscle and bone using a person’s own adult stem cells is nearly ready for prime time.
    Last week, the NIH announced to its staff that it’s creating a bone marrow-stem cell transplant center within the NIH Clinical Research Center.”

    This is the first step of a long road but maybe one day soon, the multitude of Americans suffering with diseases that can be improved with adult stem cells will not have to travel overseas for treatments. We can only hope. -DG

    http://repairstemcell.wordpress.com/2009/02/26/nih-says-adult-stem-cells-are-ready-for-the-prime-time-yah-baby/

    Like this

  3. My daughter received a kidney 20 months ago. We have already started trying to think of a way to pay for her anti rejection drugs when she reaches her 36 months. Yes, she has a supplemental insurance but it will not pay what the medicare coverage pays.
    I am writing my congressmen & senators & the president this week with my concerns. Thanks for the article!
    Kathy McLaurin
    Petal, MS

    Like this

  4. My son is on dialysis right now and I am worried about how he will pay for his medications after transplant. This is a very scary thing for people facing transplant. I have talked with others who are on dialysis and they have made the choice NOT to have a transplant because of the cost of the medications you need after, for a life time can not afford the medications. I will be writing a letter also.

    Thank you,
    Debbie

    Like this

  5. My adult son received a transplant in Jan 08 we are now worried he has no insurance and is on Medicare and SSI.The anti rejection meds and his dr’s visits and lab work that medicare pays for is Preventive and after the 36 months which will be Jan 2011.We don’t know how he going to pay for his meds dr’s appt. and lab work you have to have to check his rejection levels. I haven’t figured out why they will pay for dialysis which costs alot more than transplant and they will only cover them for 36months.When the Donor who donated the Kidney for transplantation donation would be in vain because if the transplant is rejected because of the fact that the patient didn’t have the help to pay for the meds and labs and dr’s visits and preventative treatment that they should have and would have if the government would cover all transplant patient for there whole life.
    You would have less patient rejecting a kidney or other organ and patient wouldn’t have to have to either go back on dialysis or try for a second transplant if they would have had the medical help to begin with it would make it easier for people have a chance for a transplant and the waiting list would go down. That my opinion. I have work my Senator and House of Representatives about getting the Bill passed. I
    have my family and friends writing to.I would like to find a way to tell are story to the President he need to know what is wrong with the transplant world.I will keep writing letters. I wish everyone lots of luck in there journey in the transplant world as a Mother and Caregiver i am learning as i go..
    Best of luck.
    Concern Mother

    Like this

  6. Is it true that meicare will not pay for any transplant related drugs if the person had the transplant while on the medicare 24 month waiting list. My daughter may have to have a transplant wile waiting for medicare to kick in. She is , currently, receiving Charity care.

    Like this

  7. I am 45 yrs old. I had a kidney transplant about 16years ago. I am on medicare and ssi. I am so upset and scard I don’t know what is going to happen. My husband has been working 2 jobs for the past 6 years so we have health insurence. because of the transplant NO company will take me. I know something bad is going to happen sooner then later. His father had a bad stroke because of working to much and high B/P. (my husband works from 4:30am til7:30-8:00 or later then eats and goes to bed 61/2 days a week. The point what I am trying to say is we have 2 choices. 1) He can quite his hell hole job then we have no way to pay for my meds and my labs doctors. we would loose EVERYTHING. our home then my family will loose me. all because I had had a kidney thansplant and needed my meds. OR 2) My husband could keep his 2nd job and end up in a nuresing home because of a stroks or even die. I would not have any insurence so I would get my meds ect and I would die. All because i had had a kidney transplant and needed my meds. Is there anyone out there with problems some what or the same as me I would like to talk to you. my e-mail is lilbrewerpug@yahoo.com. or if you would like to write to me thats GREAT also my address is: Lori Geitner 8422 HWY57 Baileys Harbor WI 54202. I am going to write to congressmen and senators. To anyone and everyone. WE NEED HELP!!!!! I would love to hear from everyone Lets all MAKE A DIFFERENCE. THANK YOU for your time.

    Like this

  8. my name is paul lugo.Im thirty-seven years old . I fought to be alive since I’m 25 years old .part of my story is about how hard it was for me to get my transplant .I was featured on telivision because they didn’t want to let my donor into the country so i could get my transplant well’ I got one now; Im coming on the thirty-six month rule about my medication ;question the goverment let my donor in so i could live and now after everithing i been through all the money they spent to keep me alive they are going to let me die? because i cant pay for medication thats suposed to keep me alive ?

    Like this

    • Paul:

      As I understand it Medicare will cover all expenses for life if you were old enough to get medicare at the time of your surgery. I also understand that Kidney transplant patients get free meds from Medicare even if they weren’t covered by Medicare at the time of their surgery. If you need financial help contact your transplant coordinator at the hospital where you got the transplant and they might be able to steer you in the right direction. You can also call your local Organ Procurement Organization (OPO) and ask them for suggestions. I agree the 36 month rule is stupid and that would have been fixed if the Obama health plan had passed.

      Like this

  9. Medicare Coverage :
    I have written my Congressman and House of Representatives and trying everything i can to get the word out that Transplant Patient need help with getting there Medicines that they have to take for life.My son lost his job just before he got sick in 2005.Since my son has no insurances he has to have blood work and dr’s visits.My son knows that if he should find a job that because he has a precondition that the insurance company would not cover him.So he is in a catch 22. My son had a Kidney Transplant in Jan 08. His Medicare coverage will be over in 2011.
    We have already got paperwork from Medicare this month Feb.2010 so that they can start looking at what dr’s he sees and what treatments he is on. So it really doesn’t start at 36 months they start looking at you at 24months at least that seem to be my son’s case.
    So we are gathering all the info to sent to Medicare for them to review.
    We could use some advice if any one has met there 36months if they can tell us how they fared. I am only the care giver and concerned mom who wants to help her son have a better life.

    Care Giver
    Concerned Mom
    Angela

    Like this

  10. I have End Stage Kidney Disease,employed for at least a quarter of my life, head of household, mother. I find myself financially needy, no health insurance, possessions gone, assets gone, spouse died and unemployed. Unlike my counterparts, I am pending dialysis because of no health insurance. My options are to pray continually for availability of medicines to control my blood pressure coupled with hope to begin dialysis to enable me to live. Secondly, to have Hope for the ultimate kidney transplant however, little did I know that my journey would not end with the kidney transplant! I realize that Congress and Senate must hear our appeal for help. Count me in… How can I expect someone to donate a kidney (living or deceased) and not be able to care for the precious gift of life because no antirejection medicine is affordable. How reckless and unthankful is that behavior? I don’t think that these factors are considered when laws and rules are set. There is no sense or common sense applied it seems. I thank people like you whose actions enlighten us and put a face and pulse to this issue. People who care about others, research, communicate and strive to make a difference in the heart of the matter. You blow me away.

    Like this

    • Angela…my heart breaks for you. I cannot believe that our elected officials are so insensitive as to ignore people like you, but they are. All too often they cave in to the big money of the pharmaceutical and health insurance companies and their huge campaign contributions.

      Lots of people care about you Angela, your story needs telling, telling and re-telling to everyone who will listen. Damnit congress….do something!

      Like this

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Follow

Get every new post delivered to your Inbox.

Join 2,134 other followers

%d bloggers like this: