Here's an interesting podcast from the American Society of Nephrology:
http://www.asn-online.org/publications/kidneynews/podcast.aspx (http://www.asn-online.org/publications/kidneynews/podcast.aspx)
Expansion of Immunosuppressive Drug Coverage - An Imperative Reform
Tue, 18 May 2010 12:02:00 EDT
Transplant nephrologists David Cohen, MD, and Bryan Becker, MD, discuss immunosuppressive legislative debate and next steps.
Duration: 00:24:01
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No need to download anything, just press the "Listen" button.
8)
Here's my DSEN post on the podcast:The kidney transplant community's stabbed in the back narrative (http://www.billpeckham.com/from_the_sharp_end_of_the/2010/06/the-transplant-communitys-stabbed-in-the-back-narrative.html)
By Bill Peckham
On Friday RenalWEB linked to an American Society of Nephrology podcast that is deeply frustrating.
Expansion of Immunosuppressive Drug Coverage - An Imperative Reform, presents the National Kidney Foundation's and the American Society of Transplantation's explanation of how the transplant advocacy community failed to achieve their objective of extending immunosuppressant drug coverage, under Medicare Part B, to certain kidney transplant recipients. The podcast is a companion to editorials published in the Clinical Journal of the American Society of Nephrology (ASN hopefully will make the CJASN editorials freely available).
The story according to the podcast set-up (the fist minute) is that there is "bipartisan support for extending immunosuppressant benefits for the life time of the transplant", that such an extension makes "good clinical and economic sense" however, the narrative continues, in the process of passing healthcare reform "the Senate removed" from the House's healthcare bill a provision that would have extended immunosuppressant coverage.
Given that starting point, the editorials and podcasts present two explanations for events. Bryan N. Becker, MD, the President of the National Kidney Foundation, describes events as manifesting "A Conflict of Responsibility": the NKF couldn't support the House's approach to extending benefits because the pay for would disadvantage people on dialysis. David J. Cohen, MD, American Society of Transplantation Board member, gives what I take to the be the transplant community's explanation of events: the NKF's objection to the legislation is baseless and the root motivation was profits. Cohen's charge is that the dialysis industry (aka Kidney Care Partners), sacrificed a clear benefit for transplant patients on the altar of financial gain.
Where to begin. This is wrong on so many levels. First and foremost, there is no acknowledgment that immunosuppressant drug coverage under Medicare Part B has ALWAYS been a suboptimal solution to the problem. People need more than a few medications to successfully live with a transplant. The AST and NKF are continuing to advocate for legislation that would not even cover the doctor visits needed to maintain those prescriptions. This isn't what people need.
What people living with a transplant really need is access to health insurance. Affordable health insurance which would provide access to all the medical service they need including immunosuppressant drugs. Wouldn't that be nice - access to health insurance without having to find a way into a large Employer Group Health Plan.
The idea of providing access to health insurance, including access for people with preexisting conditions, should sound familiar because the bill under discussion, the one that didn't extend immunosuppressant drug coverage, that bill did extend health insurance access to people living with a transplant.
It's always disappointing to hear nefarious motives ascribed to those who advocate for optimal dialysis but what I find frustrating is the central complaint: that a redundant half measure wasn't passed. Get over it. On January 1, 2011 we will enter a new era.
After January 1 someone on dialysis, with Medicare primary, who gets a transplant - they will have full Medicare access for 36 months and then when that is up they will have access to insurance through the new public Exchanges (if they haven't found their way into a large employer group). That's a big change. That change represents a huge win for kidney patients. Advocates should now be working to make sure the Exchange policies, and the high risk pool policies during the 2011-1014 transition period, meet the needs of those with a transplant. January 1 is less than 7 months away, the NKF and AST should be working on new messaging to spread the good news that the future is bright.