[Ip-health] Plan for Kidney Drugs Spurs Division

[Joana Ramos]

http://www.nytimes.com/2009/12/15/health/policy/15kidney.html?_r=3D1&scp=3D=
1&sq=3Dkidney&st=3Dcse


By KEVIN SACK
Published: December 14, 2009
NYT

A Congressional proposal to help pay for drugs needed by transplant
recipients to prevent rejection of donated kidneys has run into
opposition from dialysis providers, drug companies and the National
Kidney Foundation.


Senator Richard J. Durbin backs a plan to pay for expanded coverage for
transplant drugs by setting a flat fee for dialysis.


The groups have emphasized that they support extending Medicare coverage
for the drugs. But they oppose the method Congress has identified to pay
for expanded coverage, saying it would help transplant recipients at the
expense of dialysis patients by effectively reducing government
reimbursements for dialysis.

The proposal, put forward by leading Democrats, would extend Medicare
coverage of immunosuppressant drugs beyond the current limit of 36
months after a kidney transplant. To pay for that extra coverage, a
change would be made in the formula used to reimburse dialysis treatment.

<snip>

The proposal has created a rift between those in the business of
providing dialysis and those in the business of performing transplants.
The discord is being felt on Capitol Hill, and supporters of the measure
fear it may make it easy for Congress to kill the provision altogether
in the late stages of negotiation.

On Saturday, a coalition of drug makers, dialysis providers and
nephrologists known as Kidney Care Partners informed senators in a
letter that =93the kidney care community strongly objects=94 to the payment
method.

But the American Society of Transplantation actively supports the
provision and fears that opposition from the kidney groups may arrest
its momentum.

Although Medicare is primarily an insurance program for older Americans
and the disabled, it has since 1973 covered those with end-stage renal
disease, regardless of their age or condition.

The federal program now pays for most costs associated with dialysis and
transplantation. But for patients younger than 65, coverage of the
anti-rejection dugs =97 which can run from $1,000 to $3,000 a month =97 end=
s
after three years. If patients cannot afford the medications, they may
lose their donated kidneys and have to return to dialysis while awaiting
another transplant.

The policy is widely regarded as pound-foolish. Medicare spends an
average of $17,000 a year on kidney transplant recipients, most of it
for the anti-rejection drugs, compared with $71,000 a year on dialysis
patients and $106,000 for a transplant.

=93It=92s like buying someone a new car and giving them only enough gas to
drive around the block a few times,=94 said Dr. David J. Cohen, medical
director of the kidney transplant program at Columbia University Medical
Center.

The health care bill that passed the House last month includes a
provision that would provide Medicare coverage for immunosuppressant
drugs for all beneficiaries for life, starting in 2012.

To pay for the expanded coverage, House Democrats embraced a proposal
that would set a flat fee for dialysis treatments and related
medications that some providers say would not cover costs. The
Congressional Budget Office has calculated that the package would save
the government $100 million over the next 10 years.

<snip>

Shortly after the House legislation passed, 40 Democrats in that chamber
wrote to Speaker Nancy Pelosi to express concern about the bundling
payment method. Many are members of the black or Hispanic caucus, and
the letter cited kidney disease=92s disproportionate impact on members of
minorities.

Three-fourths of the signers had also accepted recent campaign
contributions from dialysis providers and drug makers. That included 26
who had received donations in the last three years from Amgen, a
California company that makes Sensipar, one of the drugs that would be
in the new reimbursement bundle.



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Joana Ramos, MSW
Cancer Resources & Advocacy
Seattle WA USA
+1-206-229-2420
http://ramoslink.info/
www.bmtbasics.org