Demonstrating yet again that they have no gift of nuance, or even common sense, Congressional Democrats are proposing to cover the cost of kidney transplant drugs at the expense of dialysis patients.
Since 1973, Medicare has covered most of the healthcare costs of those with end-stage renal disease (permanent kidney failure) regardless of age, including dialysis and transplantation. The government-run healthcare program currently ends payment for transplant anti-rejection drugs—which currently run about US$3,000 per month—after three years. Only the US Congress could institute a policy that uncaring, stupid, and wasteful. People are dying waiting for a kidney. If they get a transplant and can’t afford to pay for the anti-rejection drugs after three years, they invariably lose the organ and go back on dialysis.
According to Kevin Sack, writing for the New York Times, “Medicare spends and average of $17,000 a year on kidney transplant recipients, most of it for the anti-rejection drugs, compared with $71,000 a year on dialysis patients and $106,000 for a transplant.”
A provision of the healthcare reform bill (.pdf; 3.3MB) passed last month by the US House of Representatives extends Medicare coverage for anti-rejection drugs for transplant patients for life, starting in 2012. Unfortunately the provision is paid for by setting a flat fee for dialysis treatments and related medications—called “bundling.” Some dialysis providers argue that the new flat fee won’t cover their costs. But dialysis providers are wildly profitable—to the tune of hundreds of millions of dollars each year. They’re also wildly inefficient: Bill Peckham did the math last October (also take the time to read his comments to the Centers for Medicare and Medicaid Services on the proposed payment rule).
If this is a back-handed attempt at social engineering, at least have the anatomy to say so and remedy the organ scarcity situation. A simple solution: Make the default condition for everyone to be an organ donor and provide a clear and simple opt-out procedure for those who wish not to be donors. It really is that simple.
The US Senate version of healthcare reform does not include a provision to extend Medicare coverage for anti-rejection drugs, but Sack cites Senator Dick Durbin (D-Illinois) as having submitted just such an amendment last week. Durbin’s aides told Sack that Durbin hoped his amendment would be included in a package of amendments presented for a single up-or-down vote.
Dialysis providers want to see the extended Medicare coverage for anti-rejection drugs paid for by “delaying when Medicare would start covering kidney patients who also have private insurance,” according to Sack. (Disclaimer: I’ve been a dialysis patient for almost 10 years and have retained private insurance the entire time.)
Sack reports that after the House legislation passed, 40 Democrats wrote to Speaker Nancy Pelosi (D-California) to complain about paying for the Medicare extension with the dialysis payment bundling. “Three-fourths of the signers had also accepted recent campaign contributions from dialysis providers and drug makers. That included 26 who had received donations in the last three years from Amgen, a California company that makes Sensipar, one of the drugs that would be in the new reimbursement bundle.”
Sack fails to report that Amgen also makes Epogen, another of the drugs included in the proposed bundling. In its third quarter report, ending September 30, 2009, DaVita—one of the largest dialysis providers in the US, and the company that provides my dialysis services—reported its net profit for the first three quarters of 2009 as US$313 million. As reported earlier, fully 40% of DaVita’s US$290 million profit in 2006 came from administering Epogen. And Amgen is dead serious about defending it’s Epogen turf.
While it’s doubtful that oral drugs like Sensipar will be included in the new reimbursement bundle, IV drugs—Epogen, vitamin D, and iron—almost certainly will.
DaVita’s profits—and those of Amgen—would be seriously threatened should the proposed bundling become law. The question is, on whose behalf were those 40 Democrats acting?
0 responses. Comments closed for this article.