The Push to Extend Medicare Coverage of Kidney Failure Drugs

kidney failure drugs next to man and capitol building

For over 50 years, Medicare has covered treatment for kidney failure (also known as end-stage renal disease or ESRD), no matter the patient’s age. This coverage is for a limited time, but new studies indicate that expanding drug coverage could save patients’ lives and the government millions of dollars. 

Limited Medicare coverage

Medicare coverage for ESRD patients expires either one year after the last dialysis treatment, or three years after a successful transplant. However, those who need dialysis as well as those who have received a transplant often take multiple medications, each of which can be very expensive. In fact, a 2010 study reported that nearly 70 percent of kidney disease-related deaths were caused by the high cost of anti-rejection drugs. 

Kidney failure reform 

Now, lawmakers and advocates alike are pushing to give lifetime drug coverage to patients who need anti-rejection drugs. 

Although it might seem like this would cost the government more money, two separate federal projections show that it could save the government between $73 million and $120 million over a decade. A separate estimate by the Congressional Budget Office (CBO) estimates this move would save the government $400 million over 10 years. 

The reason this plan saves money is because it guarantees these patients have access to life-saving anti-rejection drugs, therefore decreasing the number of patients who need additional transplants and dialysis. 

Representative Ron Kind (D-WI) said in a statement, “After a transplant, patients should not have to worry about whether they can afford the treatment needed to keep their transplanted kidney.”

Trump’s plan for kidney healthcare reform

Trump is also calling for healthcare reform when it comes to kidney care. 

Earlier this month, Trump signed an executive order addressing three goals:

  1. Make sure patients receive kidneys more quickly, 
  2. Enable more patients to receive in-home dialysis, and 
  3. Encourage the development of artificial kidneys. 

The backbone of this plan comes down to saving money. In 2016 alone, Medicare spent $113 billion on kidney disease care. This accounts for more than one-fifth of Medicare’s entire spending for the year. 

Dr. Holly Mattix-Kramer, president of the National Kidney Foundation, was present for Trump’s announcement. According to her, these measures will encourage doctors to screen for, diagnose, and educate patients about kidney disease before they develop kidney failure. 

“We’re extremely excited,” she said. “For so long we felt like no one was paying attention to this epidemic of kidney disease.”

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