Landmark “Immuno Bill” an Important Step in Building Health Equity for Kidney Transplant Recipients

No one should ever have to choose between paying for life-saving medications versus paying for rent or food for their family.

 

Yet, for many people, this is a common dilemma. This is especially true for the approximately 24,000 Americans who receive a kidney transplant each year.

 

Following a kidney transplant, patients must take daily immunosuppressive drugs to help prevent the body from rejecting a new organ it views as foreign. These medications are so crucial that skipping even one dose can increase the likelihood of rejection and kidney failure[1].

 

More than 90% of patients with kidney failure have health insurance coverage through Medicare. Historically, Medicare has limited coverage of immunosuppressive drugs after a kidney transplant to three years. When patients reach that coverage date cap, the costs of their medications skyrocket. As a result, every year hundreds of patients lose their transplant and return to dialysis because they cannot afford to pay for the immunosuppressants on their own.

 

A policy change soon will help fix this problem. The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020, or the “Immuno Bill,”  was signed into law last year. This bill provides indefinite Medicare coverage of immunosuppressive drugs for kidney transplant recipients starting in 2023. 

 

“The process of getting a kidney transplant is not easy,” said Dr. Bryan Becker, chief medical officer for DaVita Integrated Kidney Care. “Medicare’s longstanding anti-rejection medication coverage limit added an obstacle to keeping a transplant and a burden to patients. This bill will save lives and taxpayer money by improving the long-term success of kidney transplants.”

 

This bill also has two additional implications. First, it addresses health equity for patients who have received a kidney transplant by impacting the relationship between a person’s health and social determinants of health, including their ability to pay for needed medications. Second, this bill falls in line with the Advancing American Kidney Health initiative and the End-Stage Renal Disease Treatment Choices (ETC) model by helping increasing patient access to transplants.

 

The “Immuno Bill” accelerates the energy providers such as DaVita have to transform kidney care, a key element of which is helping address common barriers to transplantation. Over the past 20 years, DaVita has developed patient education programs—for both before kidneys fail and after—to build greater understanding of the transplant process. In 2018, the company also instituted a “self-referral” policy, asking physicians who work with DaVita to refer every patient who wants a kidney transplant to a transplant center for evaluation.

 

Recently, DaVita announced that more than 100,000 DaVita patients have received a kidney transplant since 2000.

 

According to Dr. Becker, “The passage of this legislation calls for celebration as we double down on our commitment to be part of the solution by making it easier, not harder, for people to get a kidney transplant. We celebrate every patient who gets a kidney transplant, and we’re looking forward to another 100,000 moments of joy.”

 

[1] Hart A, Gustafson SK, Wey A, et al.  Loss of Medicare, immunosuppressive medication use, and kidney transplant outcomes.  Am J Transplant 2019; 19:1964-71.