afford medications post kidney transplant?

[st789]

Have anyone know someone decide against transplant due to lack of insurance or the highly cost of them, especially if medicare no longer pay for it or lack of insurance from job?  It would be suck if one could not afford to pay for medication and go back on dialysis, especially here in U.S.  I read several posts from other kidney sites where some have to make this difficult decision.  Thanks!

[glitter]

I am wondering about this myself...

[kitkatz]

Loma Linda makes you sign a paper that states you understand there will be a major copay for transplant drugs when you have the transplant and YOU will be financially responsible for it.  Made my hair stand on end.  States a two hundred dollar or more copay is a possibility.

[Rerun]

That is just part of a transplant.  It is outrageous.  They give you back life only to suck it out of you. 

But, yes in the transplant evaluation you will talk to a financial coordinator who will ask you if you can afford transplant copays.

[mcjane]

Read an artical once about needing medical care for a chronic disease. It all came down to if you can't afford treatment, you die.

Greatest country in the world as long as you stay healthy otherwise your screwed.

[angela515]

Most transplant ceneter will not allow you to go on the list without insurance or some other way to pay for your meds.  Luckily most social workers on the transplant team will help you and you can be on the list.

My social worker is great, after I got this kidney one of the medicines they wanted me to take was not covered by my insurance and I couldnt afford it, so they got alot of samples and gave them to me. I should only need to take this medicine first month.

[st789]

Yea, I agree with everyone.  Sometimes, the question will be to transplant or not to transplant.  Everything is about co-pay.  Would it be nice if we all hit a jackpot and not have to worry about these costly copay in U.S.  Oh well, just have to suck it up.

[angieskidney]

Read an artical once about needing medical care for a chronic disease. It all came down to if you can't afford treatment, you die.

Greatest country in the world as long as you stay healthy otherwise your screwed.

This scares the HELL out of me since in Canada I have coverage for LIFE with only a $2 co pay but I am planning to marry an American (Sandman) and he said that private insurance would cost him $400/mth from what he found so far.. He can't afford that.

Yet our original plans of him coming here it turns out that since 9-11 that it is harder to get into Canada than it is to get into the USA dispite what the American news says. It is actually easy for me to go to the States but then I would be a financial burden on Sandman.

What about Medicaid? Does it cover where Medicare doesn't? Or is it the same with 3 years after a transplant you are on your own to reject and get back on dialysis?? What a way to live! 

[angela515]

Read an artical once about needing medical care for a chronic disease. It all came down to if you can't afford treatment, you die.

Greatest country in the world as long as you stay healthy otherwise your screwed.

This scares the HELL out of me since in Canada I have coverage for LIFE with only a $2 co pay but I am planning to marry an American (Sandman) and he said that private insurance would cost him $400/mth from what he found so far.. He can't afford that.

Yet our original plans of him coming here it turns out that since 9-11 that it is harder to get into Canada than it is to get into the USA dispite what the American news says. It is actually easy for me to go to the States but then I would be a financial burden on Sandman.

What about Medicaid? Does it cover where Medicare doesn't? Or is it the same with 3 years after a transplant you are on your own to reject and get back on dialysis?? What a way to live! 

Medicaid is for people who don't really have much of an income. I didn't qualify and all I receive is 1400/month SSDI. However my children get Medicaid. There are lots of Medical Insurance plans out there, however again, most don't cover pre-exsisting conditions like being on dialysis (ESRD). Some company's have great benefits and getting insurance through your job is different, and they can't turn you down for pre-exsisting conditions. (At Least not all..) Citigroup is one of them.

[st789]

Yes,  medicaid is for people with limited income but I do not know for how long.  Interesting that you mention Citigr., even for entry level?  I wonder can you buy insurance through high risk pool if your job does not cover you.  Will some companies less likely to hire you if they know that you have pre-existing condition or one choose not to tell them?

[okarol]

Transplant Living is a project of the United Network for Organ Sharing (UNOS), a nonprofit organization that maintains the national Organ Procurement and Transplantation Network (OPTN) under contract with the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

To read more about Financing a Transplant
go to: http://www.transplantliving.org/beforethetransplant/finance/funding.aspx

You will find more info regarding:

Common funding sources to help with the costs of transplants include:

insurance
Medicare and Medicaid
charitable organizations
advocacy organizations
Veterans Administration
fundraising campaigns
prescription drugs assistance programs
TRICARE (CHAMPUS) and the Veterans Administration (VA
---------------------------------

The Partnership for Prescription Assistance brings together America’s pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that’s right for them. Many will get them free or nearly free. Its mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible.

Patients can determine which programs they may be eligible for by answering questions and using the online application wizard. Go to: https://www.pparx.org/Intro.php -- To access the Partnership for Prescription Assistance by phone, you can call toll-free, 1-888-4PPA-NOW (1-888-477-2669).

----------------------------------

Q. When are Medicare Part A benefits based on ESRD benefits terminated?
 
A. Entitlement for individuals with End Stage Renal Disease (ESRD) is governed under the Social Security Act (SSA) (Section 226A). Under the SSA (Section 226A(b)(2)), Medicare Part A benefits based on ESRD will be terminated:
• Thirty-six (36) months after the month the individual receives a kidney transplant; or
• Twelve (12) months after the month in which the individual who has not received a kidney transplant no longer requires a regular course of dialysis.

Reference: http://www.cms.hhs.gov/ - FAQ's- Centers for Medicare & Medicaid Services

---------------------------------------------

 

[Rerun]

36 months is a little short for coverage on a transplant and 12 months is a little LONG if you quit dialysis.

Good information Karol, thanks.

[livecam]

In most cases I know this isn't possible but if you can, keep your job while on dialysis.  Keeping your company medical benefits will assure that transplant med copays will be no problem.  I remember right after the transplant I was on an antiviral med (think it was valgancyclovir) or some such.  Anyway I clearly recall being told in the pharmacy that the bottle I was picking up was worth somewhere in the neighborhood of $3000.  Holy S..t, that is a really nice ten day cruise to somewhere cool!  The 20 dollar copay did not break the bank.  Having full disability roll in whle playing with my computers and radios after the transplant wasn't too shabby either.  So and I know it is hard to do this but if you can keep working during dialysis everything will go smoothly after your transplant.

[angieskidney]

In most cases I know this isn't possible but if you can, keep your job while on dialysis.  Keeping your company medical benefits will assure that transplant med copays will be no problem. 

Things are sure different in other countries. In my country, since health care comes easily paid, job coverage is harder to get. I got turned down from my job's drug and medical coverage including accidental dismemberment on-the-job.

I guess in the States every job comes with medical coverage that they can't turn you down for? How easy is it to get a job in the States if you are from another country? I am asking for myself of course 

[jbeany]

I guess in the States every job comes with medical coverage that they can't turn you down for? How easy is it to get a job in the States if you are from another country? I am asking for myself of course 

Don't we wish they all came with health insurance!  Good jobs with benefits are very hard to find in some places.  Where I live, very few jobs come with health insurance of any kind.  If you don't have a college degree, getting a job that offers benefits is very, very difficult.  I'd say more than half of the people I know up here in Northern Michigan have no health insurance.  Jobs that offer insurance are very rare and are snatched up immediately.  Job openings for non-degree positions at the local hospital, which has the best insurance coverage around, are filled the minute they are posted.  My husband has turned down several better paying jobs because of the lousy insurance. 

It's easy to get job here in the states, angie.  It's just not easy to get a good one.  Without socialized medicine, insurance is a bonus, not a given.

Part of livecam's point about keeping your work insurance is that most group coverages such as BlueCross generally will cover pre-existing conditions, so if you have the coverage, they won't dump you when you start dialysis.

[okarol]

Here is a good article with some links to follow to get financial guidance
for a transplant and the medications needed afterwards:

http://www.aakp.org/aakp-library/Insurance/

[okarol]

More help here for patients needing assistance with the cost of meds http://www.needymeds.com/

[BigSky]

More people need to contact Congress and try to have them have medicare cover payment of transplant medication for life of the transplants instead of only 36 months.  Its far cheaper for them to pay for such medication than dialysis.

[okarol]

Montel Williams is involved with this group.
For help with prescription meds go to https://www.pparx.org/Intro.php

Monday, July 23, 2007    

Contact: Ed Belkin
202-835-3460

Four Million Americans Find Help Through Partnership for Prescription Assistance

Washington, D.C. - In just over two years, the Partnership for Prescription Assistance (PPA) has connected four million individuals who are uninsured or lack adequate healthcare coverage to programs that provide prescription medicines for free or nearly free. The PPA -- sponsored by America's pharmaceutical research companies -- is the largest private-sector patient assistance effort helping low-income, uninsured and underinsured people obtain their medicines through more than 475 public and private patient assistance programs, including 180 programs offered by pharmaceutical companies. More than 2,500 brand-name and generic prescription medicines are available through the participating programs.

Cora Simpson, of Lexington, Kentucky, became the four millionth person helped by the Partnership for Prescription Assistance. The milestone was marked by a visit to Lexington by the program's national spokesman, TV talk show host Montel Williams. Simpson, a paraplegic as a result of a gunshot wound she suffered years ago, said she learned about the program while watching television. Simpson takes four medicines a day, and found nearly 10 programs through the PPA that could potentially help.

"The PPA is continuing to make tremendous inroads by assisting struggling Americans who need it most," said Billy Tauzin, president and CEO of the Pharmaceutical Research and Manufacturers of America (PhRMA). "We have worked tirelessly to make sure patients across the country are aware of the help available through the PPA, and we will continue to do so. In the coming months, the PPA buses will be making stops in hundreds of cities reaching out to even more people, who are either unaware of the program or need help in enrolling."

Williams, an Emmy-winning syndicated talk show host, says people all across the country have told him that they're benefiting from the program. So far, the buses have traveled 150,000 miles to more than 1,500 cities in all 50 states.

"Throughout my career I've tried to help people in need, and being involved in the Partnership for Prescription Assistance has given me a great opportunity to do just that," said Williams. "As a patient with multiple sclerosis, I know there are millions of Americans who don't have access to the prescription medicines they need to live healthy lives. Fortunately, the PPA provides a helping hand to those people."

Patients who need help should call the PPA's toll-free phone number (1-888-4PPA-NOW), where trained operators field calls in more than 150 languages, or visit the easy-to-use Web site (www.pparx.org).

In addition, the PPA provides information on nearly 10,000 free healthcare clinics and has connected more than 163,340 patients with clinics and healthcare providers in their communities.

More than 1,300 national and local organizations, including the American Academy of Family Physicians, American Cancer Society, Easter Seals, National Urban League and the National Association of Chain Drug Stores, are working with America's pharmaceutical research companies to help spread the word about the PPA.

[stauffenberg]

Angieskidney, by all means both of you should stay in Canada, because in the U.S. you will face countless financial cruelties and punishments throughout your life for not being healthy.  Keep in mind as well that whatever limited benefits are available now in the U.S., the general political tenor of the country is right-wing and always will be, so there will be increasing pressure to cut medical benefits of all kinds, no matter how many people have to die because of this, as long as taxes are kept low on the rich.

I was born in the U.S. and developed an incurable 'pre-existing medical condition' when I was 14, and  I knew that my life would be one of perpetual threat and worry over medical bills because of this, so I had to move to some country with a public healthcare system.  I lived for many years in European countries with a good public healthcare system, including Austria, Germany, and England, and then married my wife, who is a Canadian, and became a permanent resident of Canada through her.

The immediate family of Canadian citizens, which includes their spouses, has TOP PRIORITY for admission to Canada, so don't let anyone tell you it would be difficult for your husband to get permanent residence in Canada and eventual citizenship.  He would qualify for medical coverage as soon as he becomes a landed immigrant, which is the first stage in the process of becoming a citizen.  I went through the process and found it all quite simple.

[Jenny]

I did not know that it did not go through. Thank you.  What I said is that Adjel had to spend five months on dialysis, before he could get on any assiststance. If you are willing to wait through the red tape, it will work. It did for Adjel. We had to go down to the social security, then we had to have Mayo Clinic send the paperwork to them. And hwe had to be put on dialysis for five months, without ever missing a day. It showed that we wereserious. They were going to do it in May, but something went wrong with the insurance, so we had to postpone it until August 14, then the surgeon had two postpone it, becase he had a liver transplant, so we waited. It finally came.  We had to go down to the social security office and apply for medicare. Then, we had to get medicaid, which wasn't easy, but if you word things right, you can get it. 

[paddbear0000]

Have anyone know someone decide against transplant due to lack of insurance or the highly cost of them, especially if medicare no longer pay for it or lack of insurance from job?  It would be suck if one could not afford to pay for medication and go back on dialysis, especially here in U.S.  I read several posts from other kidney sites where some have to make this difficult decision.  Thanks!

Having struggled with finances my whole life, I can safely say that I definitely would. This thought has crossed my mind many times as I contemplate whether I should get a transplant.

[paddbear0000]

I guess in the States every job comes with medical coverage that they can't turn you down for? How easy is it to get a job in the States if you are from another country? I am asking for myself of course 

Part of livecam's point about keeping your work insurance is that most group coverages such as BlueCross generally will cover pre-existing conditions, so if you have the coverage, they won't dump you when you start dialysis.

Yeah, but if they cover you, it won't be for a while. They generally have a pre-existing clause that requires you wait 6 months or a year before they start paying for anything related to your pre-existing condition. And trust me, they make EVERYTHING you are seen for, related to your pre-existing condition, just so they don't have to pay. My pre-existing condition clause with Blue Cross Blue Shiled is a year!

[paris]

I had to change insurance companies in the middle of all of this and I had no problem. I only needed to send a letter from the prior insurance company to the new one and everything was fine. IF you lose coverage for more than 60 days, you will have the pre-existing problem, but if you have no lapse, there is continued coverage.  If fact the new insurance has been more than helpful and has covered every single thing connected with the kidney failure issue. 

[okarol]

Have anyone know someone decide against transplant due to lack of insurance or the highly cost of them, especially if medicare no longer pay for it or lack of insurance from job?  It would be suck if one could not afford to pay for medication and go back on dialysis, especially here in U.S.  I read several posts from other kidney sites where some have to make this difficult decision.  Thanks!

Having struggled with finances my whole life, I can safely say that I definitely would. This thought has crossed my mind many times as I contemplate whether I should get a transplant.

The idea of extending Medicare coverage to transplant recipients has been considered for some time now.
Renal Transplant Community Lobbies for Extended Medicare Coverage of Immunosuppressive Therapies http://www.medscape.com/viewarticle/518806
I need to research the Bills to see what's happening at the present time.