DURBIN, COCHRAN INTRODUCE LEGISLATION TO HELP ORGAN TRANSPLANT PATIENTS

[okarol]

July 29, 2011

DURBIN, COCHRAN INTRODUCE LEGISLATION TO HELP ORGAN TRANSPLANT PATIENTS
[WASHINGTON, DC] – U.S. Senators Dick Durbin (D-IL), Thad Cochran (R-MS), and Scott Brown (R-MA) today introduced bipartisan legislation to improve the quality of life for people with kidney disease.  The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act would assist thousands of Americans under the age of 65 who are being cut off from Medicare after 36 months by extending coverage of immunosuppressive drugs for kidney transplant recipients. Also cosponsoring today’s legislation were U.S. Senators Daniel Inouye (D-HI), Chuck Schumer (D-NY), Carl Levin (D-MI) and Ben Cardin (D-MD). Congressman Michael Burgess, M.D. and Congressman Ron Kind are planning to introduce companion legislation in the House of Representatives within the next few weeks.
 
“Of the 89,000 patients waiting for an kidney transplant, those patients lucky enough to undergo a successful transplant should not have to worry about being able to pay for the medication that will reduce the risk of organ rejection,” said Durbin.  “In 2000, Congress passed legislation that provided older or disabled individuals lifetime coverage for immunosuppressive drugs through Medicare.  Today’s legislation will extend that coverage to all patients trying to live healthy lives after kidney transplants.”
 
“Our legislation is intended to help people with end-stage renal disease and offset long-term costs to the government for treatment of this condition.  Kidney transplants are often the best option for these patients, and this bill would help in providing the immunosuppressive drugs needed to make transplants successful.  In states like Mississippi with high incidences of diabetes and related kidney failures, extending this coverage to younger patients could mean improved health and quality of life,” Cochran said.
 
According to United Network for Organ Sharing, approximately 28,000 organ transplants were performed last year in the United States.  The vast majority of transplants – over 16,800 Americans in 2010 – are provided to patients in need of a kidney because they are living with End Stage Renal Disease, ESRD, or kidney failure. However, for thousands of working Americans who had not yet reached 65 and were not disabled, treatment was cut off after 36 months regardless of their ability to pay for lifesaving therapy that can run more than $1,000 a month.
 
“Extending coverage beyond 36 months for those suffering from end stage renal disease is just common sense. It’s good policy, it saves money, but most importantly, it saves lives,” said Brown. “No one should lose a transplant because they are not able to pay for the drugs to maintain it.”
 
“This legislation is a commonsense approach to both maximizing taxpayer money while increasing the quality of life for kidney transplant recipients,” said Dr. Burgess who is the Vice Chair of the House Energy and Commerce Committee’s Subcommittee on Health and Chairman of the Congressional Health Care Caucus. “Without this legislation, transplant recipients face the potential of losing access to their immunosuppressive medications after 36 months which places them at a higher risk for losing their new kidney and being placed back on dialysis – a situation that has a proven higher cost to taxpayers and does not improve the quality of life.”
 
“Health care costs are the fasting growing area of spending in the national budget,” said Rep. Kind. “We should be doing everything we can to improve patient care while getting these costs under control and this legislation is a great step in the right direction. Providing kidney transplant patients access to the medication to ensure the success of their transplant helps keep health care costs down – by decreasing the need for further dialysis and the likelihood of a re-transplant - and the quality of life up – so that patients won’t have to worry about how they will pay for the medicine to maintain their health.”
 
The effects of the disparity in coverage are evidenced in the hypothetical case of a young woman.  A 26 year old woman living with ESRD would have lifelong dialysis covered by Medicare at $77,500/year. Medicare would cover the cost of a transplant at $110,000/transplant. The immunosuppressive drugs she would need to ensure the organ is not rejected by her body are only covered for 36 months and the drugs are far less costly at $10,000 to $20,000/year.  Without immunosuppressive drugs to keep kidney transplants from being rejected, many patients find themselves right back where they started: in need of a kidney. This circular cycle of care is costing taxpayers a lot of money and putting thousands of lives at risk.
 
“The National Kidney Foundation commends Senators Durbin and Cochran for their leadership on this critically important legislation. This bill will ensure that thousands of Americans can keep the transplants they have, allow thousands more to be transplanted and reduce the need for re-transplants of people who can no longer pay for vital medication and end up back on dialysis and the transplant waiting list. This legislation is a major first step towards achieving the goal of the National Kidney Foundation's END THE WAIT! initiative to find solutions to the organ shortage and eliminate the all-too-long wait for a transplant," said Lynda Szczech, MD, National Kidney Foundation President.
 
“The American Society of Transplantation representing the majority of professionals engaged in the field of transplantation applauds Senator Durbin for his strong commitment to improving the lives of transplant donors and recipients. The Durbin-Cochran Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2011 saves both lives and costs to the federal government.   It is a common sense and practical policy proposal to improve the nation's transplant system...bringing greater efficiencies to the Medicare system,” said Dr. Robert Gaston, President, American Society of Transplantation.
 
"Extending lifetime coverage for immunosuppressive drugs is the right thing to do for patients.  It guarantees patients' quality of life, saves transplanted kidneys, and saves dollars," said Joseph Bonventre, M.D., President, American Society of Nephrology.

http://durbin.senate.gov/public/index.cfm/pressreleases?ID=0e106d87-eee1-4e6b-8ef0-92851cb3103d

[MooseMom]

I wish more Congresspeople understood that sometimes you have to spend money now to save money later.  I'm glad to see this legislation has bi-partisan support.

This is the best news I've heard all day; it has been a pretty crappy day.

[jbeany]

Hurry up, please!  12 months and 24 days to go!

[Meinuk]

This legislation helps the drug companies.  Your Cell Cept and Prograf will be paid for. (you will still be responsible for the premium, and the co-pay - but it will only cover your immunosuppresives)

But you'll be on your own for Valcyte, and any other meds that you are on.  You will also be on your own for Dr's visits, and scans or blood work that you need.  And if you have to be hospitalized for anything, you'll be on your own for that.

Sadly, everything that looks great always comes with fine print. That is my glass half empty view of the bill.

But on the other hand, if I buy stock in Big Pharma, it'll be great, because the government will be guaranteeing their profits indefinitely!  My tax dollars will be helping my investment portfolio. Who needs free market competition when the government will pay for a few select drugs (and their very expensive generic counterparts).

If this passes, it will be a Pyrrhic victory.

[MooseMom]

But if it doesn't pass, what kind of loss would it be?

I am not sure I care all that much if this legislation helps drug companies.  If helping transplant patients keep their new organ functioning happens to result in bigger profits for Big Pharma, I'm willing to pay that price.  What am I missing here?  Would it be better for this legislation not to pass?  That's not a sarcastic question...really, would it be better for transplant patients if it doesn't pass?  Should we be lobbying against it?

[Meinuk]

Lobbying is a personal thing.  If one is fully informed they can lobby for what they feel is beneficial to them and their community.

I chose not to lobby for this bill (and the previous bills) because even if my meds were paid for, I would lose sleep and quality of life (even if my drugs were covered) if I were worrying about how I would pay for doctors visits, blood work, CMV, BK Virus, rejection episodes, infection, cataracts, skin cancer and all other worries that came with my transplant.

I also chose not to lobby for this bill because I do not want to or need to guarantee a fixed payment for big pharma. I want to know that my commercial insurance company will fight to protect their profits by negotiating with Big Pharma and aggressively try to bring their product prices down.

This is my choice, based on my reading of this legislation.  Every person that chooses to lobby should come to their own informed decision about every piece of legislation that they try to push through.

The loss that I see is the time that congress wastes with bills that on the surface make people really happy, and then in practice lead to woe.  Our congress is mired in false hope bills, and I see this as just that.  False hope that everything will be paid for.  It won't.

said Durbin.  “In 2000, Congress passed legislation that provided older or disabled individuals lifetime coverage for immunosuppressive drugs through Medicare.  Today’s legislation will extend that coverage to all patients trying to live healthy lives after kidney transplants.”

Medicare Part D went into effect on January 1, 2006. Which supercedes the year 2000 law that Durbin is quoting.  Immunosuppressives are covered by Part D for those with Medicare due to age or disability (other than ESRD).  He is quoting a law that no longer is in use. What they are offering in this legislation is to pay a special premium for immunosuppresives ONLY.

(Bolding MY Emphasis) Below is what I find misleading.  When you hear/read quotes like this, you assume that ALL of your benefits are being extended.  The are NOT.  It is just for your specific immunosuppressive drugs. Even though the title of the ACT is clear, the politicizing of it is nebulous and confusing. It is only bipartisan because both sides can score points for backing it. It is a political no brainer.  It makes the constituants happy, and Big Pharma donors happy.  Win/win.  Until you get a bill for 2K to test your blood for BK and CMV.

“Extending coverage beyond 36 months for those suffering from end stage renal disease is just common sense. It’s good policy, it saves money, but most importantly, it saves lives,” said Brown. “No one should lose a transplant because they are not able to pay for the drugs to maintain it.”

I had a conversation with someone from the NKF about this last year.  He explained and faffed away, and ended with "This is all we can do".  If they were blunt in the wording and said, "This bill will only pay for your immunosuppresives, and you are on your own to cover the rest of your medical care" Well, that at least would have been honest, not misleading and a start in the right direction.

I've attached a PDF of the bill that was just introduced.  Give it a read. 

As it stands, using their calculations*, if this bill is passed, my monthly premiums (before co-pay) for my prograf and cellcept would be $45.00 (based on a $115 monthly Part B premuim this goes up every year though) and my 20% monthly co pays would be $54.00 Mycophenelate and $149.00 for Tacrilomus. Total out of pocket for just my immunosuppresives (including Gv't premium) would be $248.78 a month.  Which is a great savings over no insurance at all, but how would I pay for everything else?  Now, if I lived in New Jersey and was without insurance for six months, I could apply for their Pre-existing condition insurance policy and it would pay for everything for $362.00 per month.  (NY is $425.00). here is a link to the exisiting State PCIP plans (for people with pre existing conditions: https://www.pcip.gov/StatePlans.html

If the Insurance Exchanges really are coming in 2014, anyone transplanted right now would have coverage that they could purchase through an exchange.

What really steams me is that there is so much bureaucracy in this. Why add more to Medicare for just drugs?  Why not drop the six month's no insurance clause on the State pre existing insurance coverage that exists today, and let people have full insurance? Why? Because it will cost too much. And a band-aid bill like this will placate enough people so it will look like something is being done.  Nothing to address the out of control health care costs, just something to ensure that Big Pharma will have a steady revenue stream (name brand and generic alike) and people will still be struggling to pay for their doctor's visits and medical care.  But their pills will only cost a couple of hundred dollars a month.

I am looking a gift horse in the mouth and finding that it isn't even a horse at all, it is a Trojan Horse, and our city is being destroyed.

 

*Such premium shall be equal to 35 percent of the monthly actuarial rate for enrollees age 65 and over, determined according to paragraph...

[MooseMom]

Well, it will be years and years before I see even the top end of the waiting list, so this is not a battle that I'm going to engage in for now.  By the time I get a transplant, if ever, the rules will probably have changed again, but I hope those people who need financial help now after transplantation will get it, but it's highly unlikely in our current political climate that any American taxpayer would be willing to help out a fellow human being.  The United States of America has lost sight of how to invest in its people.