Win-Win as Medicare Coverage of Kidney Transplant Drugs Is Extended

Mitchel L. Zoler, PhD

December 24, 2020

A newly passed US law ensures, starting in 2023, that for Medicare patients who receive a kidney transplant, insurance coverage of immunosuppressant drugs that prevent rejection of the organ will not end after 3 years. Currently, nearly 400 patients a year lose their transplant and return to dialysis because of not being able to afford the immunosuppressants.

The "Immuno Bill" that remedies this, formally known as the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019, was passed by the Senate on December 22 following approval earlier in the month by the House of Representatives.

The new law extends Medicare coverage of immunosuppressant drugs for kidney transplant patients indefinitely. Currently, coverage is limited to a period of 36 months. The change kicks in January 1, 2023.

An Enormous Win for Patients, Saving Millions of Dollars for Medicare

The action won wide praise from the clinical community.

"This bipartisan, common-sense policy will directly improve the lives of hundreds of transplant patients and help increase the number of transplants available to patients," said Anupam Agarwal, MD, president of the American Society of Nephrology (ASN), in a written statement.

"The bill's passage represents an enormous win for patients and the fulfillment of a top ASN priority. The society stands ready to work with policy makers to implement this legislation," he said.

Michelle Josephson, MD, chair of the ASN Policy and Advocacy Committee, added: "I am thrilled to see this critical legislation pass Congress. I have cared for too many patients who have lost their kidney transplants because they could not afford their immunosuppressive medications after Medicare ceased coverage at 36 months, only to return to more-expensive dialysis."

And Marwan S. Abouljoud, MD, president of the American Society of Transplant Surgeons, noted in a separate statement: "Medicare's limitation on immunosuppressive drug coverage was never able to be justified medically, economically or ethically, and I am thankful Congress has finally taken action on this much-needed reform."

The new law specifies that Medicare will cover the cost of immunosuppressive drugs indefinitely if no other coverage is available.

A Congressional Budget Office analysis released in November 2020 estimated that this step will save Medicare more than $400 million through 2030 by preventing patients from losing a transplanted kidney and resuming hemodialysis.

The American Society of Transplantation noted that the US organ-transplant community had worked on this change in Medicare policy for roughly 20 years.

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