Future of Medicare immunosuppressive drug coverage for kidney transplant recipients in the United States

Abstract

Kidney transplantation is the preferred treatment for patients with ESRD. It improves the quality of life in recipients, increases patient survival, and is also substantially less costly than maintenance dialysis. Long-term transplant success requires immunosuppressant drug therapy for the life of the allograft. Under current law, Medicare coverage for most recipients (except for those recipients over 65 years of age or with nonkidney-related disabilities) lasts only 3 years, leaving many recipients unable to afford these medications. Lack of drug therapy often leads to allograft rejection, resulting in premature graft failure, return to dialysis, or death. This article reviews the current policy for Medicare immunosuppressive drug coverage and analyzes the potential impact of pending legislative proposals H.R. 2969 and S. 1454 and the Patient Protection and Affordable Care Act.

Figure 1.

Sources of prescription drug coverage for kidney transplant recipients by year.

Figure 2.

Sources of prescription drug coverage by year for Medicare-enrolled kidney transplant recipients by age and years post-transplant.

Figure 3.

Estimated annual percent allograft failure due to medication non-compliance.