Update on the Immunosuppressive Bill

Rachel Shaffer
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Advocating for passage of the Comprehensive Lifetime Immunosuppressive Drug Coverage Bill—in collaboration with the transplant and kidney communities (particularly the American Society of Transplantation)—is one of ASN’s top public policy priorities this year.

In June, ASN responded to a request from the House and Senate offices of the bill’s co-sponsors, Rep. Michael Burgess, MD, (R-TX), Rep. Ron Kind (D-WI), and Sen. Richard Durbin (D-IL), for information that could be helpful in reducing the Congressional Budget Office’s (CBO) estimate of how much the bill would cost.

ASN conducted a comprehensive review of every state’s individual “benchmark plans”—which define the minimum amount of coverage all insurance companies operating in that state will have to provide patients as of October 1, 2013—to assess the extent to which they cover immunosuppressive drugs. Fortunately, it appears that every benchmark plan covers at least one of every type of drug in the immunosuppressive regimen.

With the help of former Centers for Medicare and Medicaid Services (CMS) Chief Medical Officer and ASN member Barry M. Straube, MD, the society also examined trends in generic immunosuppressive drug utilization, and found that the average cost of the two most commonly used types of immunosuppressive drugs has declined by 55% and 57%, respectively, since the CBO last estimated the bill’s cost.

The implications of these two findings could potentially have significant ramifications for the bill’s likelihood of passage. Because Americans are supposed to purchase health insurance starting in 2014—and it appears that most states will cover at least some immunosuppressive drugs—fewer people will need Medicare to provide their drug coverage. And, because the cost of the drugs has decreased due to increased utilization of generic products, the drugs Medicare does need to cover will be less expensive than in the past.

The net result: CBO could determine that the bill costs less than previous estimates, thereby increasing its likelihood of being passed into law in a difficult economic climate. “From a policy perspective, the Immuno bill already enjoys strong bipartisan support,” said ASN Public Policy Board Chair Thomas H. Hostetter, MD. “Most members of Congress agree that providing lifetime coverage is the right choice and the bill enjoys bipartisan support in the House and Senate.”

However, CBO, the independent entity that estimates how much legislation will cost, does not take into account downstream savings from keeping patients with healthy transplants off dialysis as a result of covering their immunosuppressive drugs. CBO focuses primarily on the up-front cost (the drugs) rather than the long-term savings achieved by keeping patients off dialysis. “As a result, even though we and many members of Congress recognize that the bill is the right thing for patients, the CBO’s cost estimate is a challenge at this time,” Hostetter added.

“The last time CBO officially estimated the cost, it concluded that the bill would cost approximately $600 million over 10 years. Given the challenging economic climate in Washington, DC, it is difficult to extend any Medicare benefits or other entitlement programs that have any cost associated with their implementation,” said Troy Zimmerman of the National Kidney Foundation. “Anything we can do to lower the cost would be beneficial.”

“With strong bipartisan champions for the bill on both the House and Senate side and this new information that could potentially reduce the score, we are hopeful that the bill’s odds of passage are better this year than in the past—and we’re all committed to working collaboratively as a community to help move it forward,” said Kathryn Schubert, the American Society of Pediatric Nephrology’s Washington representative.

Look for more updates on the Immuno Bill in future issues of Kidney News, and please visit the ASN Public Policy webpage to communicate with your members of Congress encouraging them to support this crucial legislation.