Protect state investment

[okarol]

Protect state investment
By Fred Sledge
Posted: 05/25/2009 06:17:13 PM PDT


It's been 15 years since I was first diagnosed with renal failure. I was only 19, yet I realized I would have to spend the rest of my life dealing with uncertainty. Would this new treatment work? Will I have to see another doctor? Will my insurance cover my dialysis? Between medical treatment, dialysis and doctor's appointments, it's a wonder I had time to fall in love.

Since then, I've used medication and then dialysis to stop the progression of my disease. Last year, my care team determined a kidney transplant was my best hope for survival, and I was placed on the waiting list. The odds were daunting; there are more than 20,000 patients on the waiting list in the California. I was one of the lucky ones -- one of the 3,000 patients fortunate enough to receive an organ in 2008.


Upon my release from the hospital, I had a daily prescription regimen that included 20 drugs. One of those drugs, my immunosuppressant therapy, I will need to take for the remainder of my life. This therapy helps prevent organ rejection, which occurs when the transplant recipient's immune system attacks the transplanted organ.


I appreciate the assistance afforded me by Medi-Cal; the state stepped in when I needed help and paid for my medication, dialysis and transplant.


But come this October, I will no longer be eligible for coverage. Medi-Cal will no longer recognize my condition as "disabled." From blood-pressure medication to immunosuppressant therapy, I will be fiscally responsible for the nine or more prescriptions I take daily. The immunosuppressant therapy alone can cost $11,000 or more per year.

Given my condition, I had to give up my job; thus, I don't have health benefits to properly manage my condition. This is true for many patients who received a transplant last year. Like me, many of them will be unable to handle the financial burden. We may even be forced to discontinue our anti-rejection drugs, putting the transplanted organ -- and our overall health -- at risk.


If rejection occurs, a patient like me would be forced to go back on dialysis, thus renewing my disability under Medi-Cal. Medi-Cal would even cover the expenses for dialysis. The $119,000 cost associated with rejection and re-transplantation is six times the cost of continued immunosuppressant drugs for one year.


This seems illogical. Discontinuing drug coverage wont reduce costs. Rather, it increases the chance that the state will have to cover additional medical costs. The continuation of immunosuppressant coverage is the most cost-effective mechanism to accomplish the end result: healthy patients and a healthy healthcare budget.


Passage of AB 998, a bill currently being considered by the California Legislature, will help the state accomplish the goal. The bill extends Medi-Cal coverage of immunosuppressant drugs after the first year post-transplantation.


I strongly support and encourage others to recognize the critical need for this legislation. Support of this bill will protect the investment the state of California has made in the patient and the transplant by ensuring patients have the tools they need for long-term success.


---


The author lives in San Ansel-mo. The Assembly Committee on Health is expected to take up AB 990 this week.

http://www.thereporter.com/opinion/ci_12447578

[Wallyz]

So sad that this is an issue.

[KarenInWA]

What I want to know is why do "they" consider a transplant a "cure", and say that the transplant patient no longer has ESRD?  Given that once the medication stops, the transplanted kidney stops functioning, that tells me that said patient is not "cured", and should still be considered "disabled", because without the needed medication, they are.  No one *wants* to take 20 pills a day at an expensive cost, and some that come with less than attractive side effects.  Why can "they" not understand this?  Not to mention the obvious financial point that the author so eloquently covered.

It's enough to make me 

KarenInWA