Potential game-changing exchange: Extending coverage for immunosuppressant drugs beyond 3-year limit for patients after a kidney transplant could help Medicare

By David White

Please see a statement on the below exchange from ASN President Mark Rosenberg. 

 

In a potentially game-changing exchange yesterday at a House Appropriations subcommittee hearing, Health and Human Services (HHS) Secretary Alex M. Azar, II, stated that a preliminary HHS Office of the Actuary analysis indicates that the savings generated by averting dialysis would be greater than the cost required to extend coverage for immunosuppressant drugs.  While noting that any potential savings would be “specific to the design of any actual policy,” the secretary underscored that HHS is “very focused on ways we can incentivize toward transplantation.”

The preliminary analysis from the Office of the Actuary points towards potential savings is significant news. For years, one of the chief challenges to passing legislation that extends lifetime Medicare coverage of immunosuppressive drugs for kidney transplant patients has been concerns regarding the cost of the legislation.

Findings indicating that providing lifetime coverage may in fact save, instead of cost, Medicare money would likely facilitate enactment of legislation to extend immunosuppressive coverage beyond the existing three-year window. Notably, however, it is the Congressional Budget Office—not the HHS Office of the Actuary—that is responsible for determining the official projected cost of legislation.

Last month, representatives from the American Society of Nephrology (ASN) and other kidney community stakeholders discussed with Secretary Azar and other HHS leadership how helpful obtaining data regarding the potential cost or savings of extending immunosuppressive coverage beyond the three-year window would be.

Secretary Azar’s comments came in response to a question from kidney care champion Representative Jaime Herrera-Beutler (WA-3), who highlighted that “often times we see people who lose their transplants get back on dialysis, because Medicare won’t cover it. And the cost and quality of life issues are ridiculous: it’s a lose-lose.”

“Extending coverage of the immunosuppressant drugs could help patients avert dialysis in the future, supporting transplantation, which of course is a better health outcome at a lower cost,” Secretary Azar went on to assert.

ASN, together with other kidney community advocates, will build upon this promising momentum to urge Congress and HHS to work together to extend immunosuppressive coverage.

Exchange

Question from Representative Jaime Herrera-Beutler (WA-3rd District):

I also want to applaud you for your recent remarks on transforming kidney care. Now, I don’t know if you know, but I’m a lead sponsor on the Living Donor Protection Act with Congressman Nadler, and kidney care has been a consistent priority for me here in Congress. The issue of immunosuppressant drug coverage after transplant is an issue that I’ve been focusing on… for several years I’ve been looking at these policies to extend Medicare coverage for those drugs to patients post-transplant, because what happens is, despite the best intentions of the ACA, folks get their transplant and can’t get something covered and then often times we see people who lose their transplants get back on dialysis, because Medicare won’t cover it. And the cost and quality of life issues are ridiculous- it’s a lose lose.

So, I was wondering if the office of the actuary has taken a look at the budgetary effects of extending immunosuppressive coverage because its more expensive to dialyze and then transplant someone a second time, and if not, may I ask that you take a look and maybe provide that analysis?

Response from HHS Secretary Azar:

So, as I mentioned in my recent remarks, we’re very focused on ways we can incentivize toward transplantation and working with you on the Living Donor issues, etc. that you focused on. Extending coverage of the immunosuppressant drugs could help patients avert dialysis in the future, supporting transplantation, which of course is a better health outcome at a lower cost. So, while the savings would be specific to the design of any actual policy, our preliminary office of the actuary analysis indicates that the savings generated by averting dialysis would be greater than the cost required to extend coverage for immunosuppressant drugs. And we’re happy to follow up with you and other interested members on this issue.

The exchange took place in a hearing on the HHS budget request for FY 2020 before the House Appropriations’ Subcommittee on the Departments of Labor, Health and Human Services, Education, and Related Agencies, March 13, 2019.

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Please see a statement on the below exchange from ASN President Mark Rosenberg. 

 

In a potentially game-changing exchange yesterday at a House Appropriations subcommittee hearing, Health and Human Services (HHS) Secretary Alex M. Azar, II, stated that a preliminary HHS Office of the Actuary analysis indicates that the savings generated by averting dialysis would be greater than the cost required to extend coverage for immunosuppressant drugs.  While noting that any potential savings would be “specific to the design of any actual policy,” the secretary underscored that HHS is “very focused on ways we can incentivize toward transplantation.”

The preliminary analysis from the Office of the Actuary points towards potential savings is significant news. For years, one of the chief challenges to passing legislation that extends lifetime Medicare coverage of immunosuppressive drugs for kidney transplant patients has been concerns regarding the cost of the legislation.

Findings indicating that providing lifetime coverage may in fact save, instead of cost, Medicare money would likely facilitate enactment of legislation to extend immunosuppressive coverage beyond the existing three-year window. Notably, however, it is the Congressional Budget Office—not the HHS Office of the Actuary—that is responsible for determining the official projected cost of legislation.

Last month, representatives from the American Society of Nephrology (ASN) and other kidney community stakeholders discussed with Secretary Azar and other HHS leadership how helpful obtaining data regarding the potential cost or savings of extending immunosuppressive coverage beyond the three-year window would be.

Secretary Azar’s comments came in response to a question from kidney care champion Representative Jaime Herrera-Beutler (WA-3), who highlighted that “often times we see people who lose their transplants get back on dialysis, because Medicare won’t cover it. And the cost and quality of life issues are ridiculous: it’s a lose-lose.”

“Extending coverage of the immunosuppressant drugs could help patients avert dialysis in the future, supporting transplantation, which of course is a better health outcome at a lower cost,” Secretary Azar went on to assert.

ASN, together with other kidney community advocates, will build upon this promising momentum to urge Congress and HHS to work together to extend immunosuppressive coverage.

Exchange

Question from Representative Jaime Herrera-Beutler (WA-3rd District):

I also want to applaud you for your recent remarks on transforming kidney care. Now, I don’t know if you know, but I’m a lead sponsor on the Living Donor Protection Act with Congressman Nadler, and kidney care has been a consistent priority for me here in Congress. The issue of immunosuppressant drug coverage after transplant is an issue that I’ve been focusing on… for several years I’ve been looking at these policies to extend Medicare coverage for those drugs to patients post-transplant, because what happens is, despite the best intentions of the ACA, folks get their transplant and can’t get something covered and then often times we see people who lose their transplants get back on dialysis, because Medicare won’t cover it. And the cost and quality of life issues are ridiculous- it’s a lose lose.

So, I was wondering if the office of the actuary has taken a look at the budgetary effects of extending immunosuppressive coverage because its more expensive to dialyze and then transplant someone a second time, and if not, may I ask that you take a look and maybe provide that analysis?

Response from HHS Secretary Azar:

So, as I mentioned in my recent remarks, we’re very focused on ways we can incentivize toward transplantation and working with you on the Living Donor issues, etc. that you focused on. Extending coverage of the immunosuppressant drugs could help patients avert dialysis in the future, supporting transplantation, which of course is a better health outcome at a lower cost. So, while the savings would be specific to the design of any actual policy, our preliminary office of the actuary analysis indicates that the savings generated by averting dialysis would be greater than the cost required to extend coverage for immunosuppressant drugs. And we’re happy to follow up with you and other interested members on this issue.

The exchange took place in a hearing on the HHS budget request for FY 2020 before the House Appropriations’ Subcommittee on the Departments of Labor, Health and Human Services, Education, and Related Agencies, March 13, 2019.

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Date:
Thursday, March 14, 2019