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Author Topic: S 323 and H.R. 1325 should not be supported  (Read 3796 times)
Bill Peckham
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« on: March 30, 2013, 12:31:58 PM »


Congressional Corner the DaVita Dialysis Patient Citizen's blog has a post up touting the latest attempt to legislate coverage for immunosuppressant drugs for the life of a kidney transplant.

http://dialysispatients.wordpress.com/2013/03/22/congressional-corner-march-two-transplant-bills-introduced-in-congress/
Quote
March - Two Transplant Bills Introduced in Congress

By Carrie L., Director of Congressional and State Relations


Recently, two bills relating to kidney and organ transplants have been introduced in Congress. Senator Richard Durbin of Illinois and Senator Thad Cochran of Mississippi introduced the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2013 (S. 323) in the Senate and Congressman Michael Burgess and Congressman Ron Kind introduced a companion bill (H.R. 1325) in the House. If passed, these bills will extend Medicare immunosuppressive drug coverage for kidney transplant patients under 65 years old for the life of the graft. Under current law, Medicare beneficiaries who are under 65, and therefore only eligible for Medicare due to their ESRD diagnosis, lose Medicare coverage 3 years after their transplant. Without the immunosuppressive drugs, the body will reject the transplant and a patient must go back on dialysis. Currently, these drugs cost about $24,000 a year while dialysis costs almost $86,000. This means it costs Medicare an additional $62,000 per year per patient that loses drug coverage. . DPC fully supports this bill and will be working diligently with its cosponsors and with our partners in the kidney community to get it passed.


Additionally in February, the HIV Organ Policy Equity (HOPE) Act was introduced in both the House of Representatives and Senate. The HOPE Act allows for the study of the safety and effectiveness of organ transplants from HIV-positive deceased donors to HIV-positive recipients. The act doesn't make this type of donation possible, but allows researchers to determine if this is safe and effective. If studies find these transplants safe and effective, this procedure has the potential to lower waiting time on organ transplant lists for all patients, as experts estimate that an additional 500 organs each year could be available for transplantation. Congresswoman Lois Capps (CA-24) is the lead sponsor in the House and Senators Barbara Boxer (CA) and Tom Coburn (OK) are leading the charge in the Senate.


For some great news, the HOPE Act was passed out of the Senate Health, Education, Labor and Pensions (HELP) committee and positively recommended to the full Senate in March, the first step towards passage! DPC thanks all of these Members of Congress for their support of kidney patients across the country.
These bills have the potential to increase access to transplants for all kidney patients on the waiting lists. DPC and the kidney community will be working hard to garner as much support for these bills as possible and to get them passed into law!


"Currently, these drugs cost about $24,000 a year while dialysis costs almost $86,000. This means it costs Medicare an additional $62,000 per year per patient that loses drug coverage. . DPC fully supports this bill and will be working diligently with its cosponsors and with our partners in the kidney community to get it passed."

It is not in my interest for DPC to overstate the cost of dialysis. I wish they would stop using misleading data.

That $86,000 figure includes Part A, Part B and Part D average Medicare spending for a Medicare beneficiary who is using dialysis. The average cost of the dialysis portion is about $26,000 per year per beneficiary (cite http://www.medpac.gov/chapters/Mar13_Ch06.pdf ; figure 6-4) the average cost to Medicare to reimburse for a year of dialysis, if someone attends 156 routinely scheduled session would be about $31,200. Any money this legislation saves money, is money primarily saved by shifting the costs to the person with the kidney transplant.

This is the big problem with this legislation: someone who is living with a transplant they will need more than a handful of medications for the graft to thrive. Foremost they will need a doctor to prescribe the medications; this legislation does not provide for any physician reimbursement! The $86,000 figure includes physician reimbursement. People living with a transplant will require diagnostic testing, this legislation does not provide for diagnostic testing reimbursement; that $86,000 figure includes reimbursement for diagnostic testing. People living with a transplant will, on average, require numerous medications in addition to immunosuppressants; the cost of these blood pressure meds, thyroid meds, etc are included in that $86,000 number.

But the news isn't all bad because after January 1, 2014 people living with a kidney transplant will have access to health insurance through federal or state insurance created by the Affordable Care Act (aka Obamacare). Clearly people living with a kidney transplant, but without Employer Group Health Plan coverage, will have to purchase insurance, subsidized or otherwise. This insurance will cover all of the healthcare someone living with a transplant needs - the doctor visits, hospital visits, diagnostic testing and the full spectrum of medications - unless this legislation is signed into law.

If this legislation is signed into law it will likely mean that insurance through the exchanges will require people living with a kidney transplant to purchase the Medicare supplemental immunosuppressant coverage in order to have coverage for immunosuppressant drugs. People with a kidney transplant will be purchasing insurance through the exchanges, most likely they would choose the highest value insurance available, one with a 10% copay, but unlike every other category of transplant recipients e.g. heart, liver, lungs, if this legislation passes kidney transplant recipients will need to spend an additional $400 a year on 80% coverage for their critically needed meds.

I suggest people with kidney disease advocate to kill this legislation. People with a kidney transplant should not have to pay more for their health insurance coverage.
« Last Edit: March 30, 2013, 12:34:20 PM by Bill Peckham » Logged

http://www.billpeckham.com  "Dialysis from the sharp end of the needle" tracking  industry news and trends - in advocacy, reimbursement, politics and the provision of dialysis
Incenter Hemodialysis: 1990 - 2001
Home Hemodialysis: 2001 - Present
NxStage System One Cycler 2007 - Present
        * 4 to 6 days a week 30 Liters (using PureFlow) @ ~250 Qb ~ 8 hour per treatment FF~28
WishIKnew
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Alports, dialysis '07-'12,cancer'11,transplant '12

« Reply #1 on: March 30, 2013, 02:48:27 PM »

Wow!   I really need to study this.
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KarenInWA
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« Reply #2 on: March 30, 2013, 03:10:21 PM »

When looking at my prescription benefits for the entire year of 2012 (transplant received November 23, 2011) the total cost of ALL of my meds was $9565.43. I wonder where they get these quotes of $24000 a year from? Or, am I just on inexpensive meds? I do take generic Prograf (tacrolimus) and haven't had any problems with it.

And yes, I agree, we kidney tx patients need healthcare coverage for our dr visitis, lab draws and everything else that goes with living, too!

KarenInWA
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1996 - Diagnosed with Proteinuria
2000 - Started seeing nephrologist on regular basis
Mar 2010 - Started Aranesp shots - well into CKD4
Dec 1, 2010 - Transplant Eval Appt - Listed on Feb 10, 2012
Apr 18, 2011 - Had fistula placed at GFR 8
April 20, 2011 - Had chest cath placed, GFR 6
April 22, 2011 - Started in-center HD. Continued to work FT and still went out and did things: live theater, concerts, spend time with friends, dine out, etc
May 2011 - My Wonderful Donor offered to get tested!
Oct 2011  - My Wonderful Donor was approved for surgery!
November 23, 2011 - Live-Donor Transplant (Lynette the Kidney gets a new home!)
April 3, 2012 - Routine Post-Tx Biopsy (creatinine went up just a little, from 1.4 to 1.7)
April 7, 2012 - ER admit to hospital, emergency surgery to remove large hematoma caused by biopsy
April 8, 2012 - In hospital dialysis with 2 units of blood
Now: On the mend, getting better! New Goal: No more in-patient hospital stays! More travel and life adventures!
Speedy1wrc
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« Reply #3 on: March 30, 2013, 05:39:19 PM »

The cost for my immunosuppression post transplant was on the order of $4,000/month. I believe their estimates on that part.

I will reread the bill's again, but I think I support them. For the first 3 years post transplant Medicare covered 100% of my immunosuppressant's. After that I paid the standard co-pay for my supplement plan. Once I hit the gap I could barely afford them. Based on their cost I hit the gap very quickly too. That meant I paid for all my prescriptions heavily.

If Medicare covers the cost of immunosuppressant drugs then that money comes out of the gap equation and I probably wouldn't hit the gap. Also, I will still get coverage for my other med's regardless of the immunosuppressant coverage.

On the surface ar least I like the bill's.
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Bill Peckham
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« Reply #4 on: March 30, 2013, 11:17:43 PM »

The cost for my immunosuppression post transplant was on the order of $4,000/month. I believe their estimates on that part.

I will reread the bill's again, but I think I support them. For the first 3 years post transplant Medicare covered 100% of my immunosuppressant's. After that I paid the standard co-pay for my supplement plan. Once I hit the gap I could barely afford them. Based on their cost I hit the gap very quickly too. That meant I paid for all my prescriptions heavily.

If Medicare covers the cost of immunosuppressant drugs then that money comes out of the gap equation and I probably wouldn't hit the gap. Also, I will still get coverage for my other med's regardless of the immunosuppressant coverage.

On the surface ar least I like the bill's.


Are you talking about the Medicare Part D gap? This legislation wouldn't change coverage for people 36 months post transplant who have access to Medicare due to age or disability.



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http://www.billpeckham.com  "Dialysis from the sharp end of the needle" tracking  industry news and trends - in advocacy, reimbursement, politics and the provision of dialysis
Incenter Hemodialysis: 1990 - 2001
Home Hemodialysis: 2001 - Present
NxStage System One Cycler 2007 - Present
        * 4 to 6 days a week 30 Liters (using PureFlow) @ ~250 Qb ~ 8 hour per treatment FF~28
Speedy1wrc
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« Reply #5 on: March 31, 2013, 06:25:12 PM »

Yes, the Part D gap.
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