Duncan transplant patient loses drug benefit
AFTER 3 YEARS, MEDICARE PROGRAM STOPS PAYING FOR ANTI-REJECTION MEDICATION
BY WENDY K. KLEINMAN
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Published: November 30, 2008
All a Duncan man knows about his organ donor is what they had in common: They were about the same age and were outdoorsmen. The Arizona man died following a motorcycle crash; his kidney and pancreas now belong to Mike Reddin.
Mike Reddin
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Transplant patient Mike Reddin
Nov 29Patient Mike Reddin talks about hardship of paying for medication...
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at a glance
BY THE NUMBERS
MEDICARE
Figures for Medicare’s private fee-for-service plans (as of July 1, 2007):
• 355,249: Number of chronic kidney failure enrollees
• $106,000: Cost of a kidney transplant
• $71,000: Per dialysis patient, including other health care needs
• $17,000: Per patient with a functioning transplant, for anti-rejection drugs and other health care needs TRANSPLANTS Oklahomans on the national transplant waiting list (as of Nov. 21)
• 436: Number waiting for a kidney
• 21: Number waiting for a kidney and pancreas Sources: Centers for Medicare & Medicaid Services, National Kidney Foundation, Organ Procurement and Transplantation Network, Dr. Jose Elamm, End Stage Renal Disease Network 13
WHAT’S AHEAD
Help on the way?
Bills were introduced in the U.S. House and Senate this year that would have eliminated the three-year limit on anti-rejection drug coverage, but neither bill was heard, said Troy Zimmerman, vice president of government relations for the National Kidney Foundation. The bills would have extended coverage only for the drugs, not for other health costs. Zimmerman said the change would be good economically because the drugs are cheaper than dialysis. It also would allow more people to consider a transplant and improve their quality of life.
Zimmerman hopes legislation gets passed. "The fact that they (members of President-elect Barack Obama’s administration) are going to be looking at health care coverage in a broader sense, that helps our chances,” he said.
Medicare doesn’t have a position on the issue. "The limit on the anti-rejection drugs is statutory. Congress is the boss,” agency spokeswoman Ellen Griffith said.
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Wondering why
Medicare’s policy is to cover people with chronic kidney failure, regardless of age. It pays for dialysis, transplants and even some medical expenses that aren’t related to kidney problems.
Although End Stage Renal Disease Medicare will pay for dialysis indefinitely, the federal health insurance program stops paying for post-transplant drugs after three years.
Patients in most cases must take the drugs the rest of their lives to keep transplanted organs, which their bodies view as foreign objects.
Reddin knew his three-year mark was approaching, but didn’t realize just how much he would have to pay because he never saw a bill from the time he went on dialysis in 2003 until a few months ago.
"Six hundred dollars out of me and my wife’s paycheck, that’s a big chunk,” Reddin said.
The $600 is after his employer pays a portion and he uses manufacturer’s coupons.
There are no generics for the three Prograf and six Myforic pills he has to take every day.
Reddin relies on his parents to pay for the drugs.
"It’s embarrassing,” Reddin said. "And it makes you wonder why. I mean, I pay thousands of dollars worth of taxes out of my paycheck — and I know every American does — and it’s not just kidney people, it’s people with cancer, heart problems, diabetes — all this medicine is high.”
There are assistance programs available, but Reddin is not eligible for them because he works.
"It looks like if you’re working you get punished. ... I’m hoping somewhere out there’s assistance, but it’s not looking good,” he said.
"It’s been hard,” said his wife, Delisa.
"There’s things that we’re not able to do for our kids. ... We have one that’s trying to work hisself through college. ... We’d love to go send him to college but financially we’re not able to.”
Don’t plan ‘too far ahead’
There is a drop in survival for transplant patients after three years because some patients can’t afford the drugs, said Dr. Jose Elamm, a transplant nephrologist at Integris Baptist Hospital, where Reddin goes for checkups. Some patients ration their supply, he said.
That accounts, in part, for what Elamm said is a "significant number” of people on a waiting list for another transplant.
About 3,000 transplanted kidneys fail every year and an estimated 12 percent of those are due to noncompliance associated with drug costs, said Troy Zimmerman, a vice president with the National Kidney Foundation.
Reddin was diagnosed with diabetes at age 5.
He should live at least another decade if he continues taking the anti-rejection drugs.
The average life expectancy of a diabetic on dialysis is three years, Elamm said. But the average life of an organ from a living donor is 15 years, and the recipient can live longer back on dialysis.
The Arizona donor’s body was kept alive until the transplant.
"I take everything day-by-day now,” Reddin said. "You don’t want to plan too far ahead.”
Related Topics:
Health and Fitness, Medicine, Medical Specializations, Diabetes, Metabolic Disorders, Kidney Failure, Internal Medicine
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