Buried in the House and Senate versions of the mammoth health care bills pending in Congress are provisions that were previously separate bills, S.565 and H.R.1458, to extend the Medicare entitlement for coverage of immunosuppressive drugs after a kidney transplant.

As I mentioned in an Aug 2009 blog post, Medicare covers the cost of most dialysis treatment and kidney transplants, regardless of the patient’s age. However, it will only pay for 36 months of anti-rejection medication after a kidney transplant. After that, the kidney recipient must pay for the immunosuppressive drugs themselves (or through a pharmaceutical discount program, or private insurance, or through Medicare if the patient qualifies because of age or disability status).

I’m a libertarian and am usually against government subsidies for specific goods since they distort markets. But once the government decides to fund kidney transplants it is a waste of taxpayers’ money to not cover the cost of meds. As the Renal Support Network states:

“Immunosuppressive drugs are expensive, but the alternative is even more costly. Medicare spends $17,300 per patient on anti-rejection medications to maintain a transplant, but if the kidney transplant fails, the person returns to dialysis at a cost of over $68,600 per year to Medicare. And because dialysis is physically draining, quality of life often suffers too. This also includes the loss of an organ that can cost between $100,000 and $210,000 to transplant. The gift of organ donation is too precious in these times of scarce medical resources not to provide for sustaining its viability.”

There is a frustrating story in the New York Times last week that highlights this issue. It describes how a woman who received a kidney from her mother lost it because she became unemployed, no longer had health coverage, and was unable to afford her immunosuppressant medication. The story has a promising ending as she has received a second transplant, but the 36 month clock is counting down once again.

NYTimesKidney  Photo from NY Times

I would be very disappointed if the kidney I donate was lost simply because the recipient couldn’t afford his/her meds. I hope that doesn’t happen. However, knowing that the transplant may fail doesn’t deter me from proceeding without reservations.

[Update1: The House version of the health care bill, H.R.3962, passed on Nov 8. It contains the extension of Medicare coverage for immunosuppressive drugs after a kidney transplant.]

[Update2: Not everyone agrees that increasing the subsidy is good. See this later blog post for details.]

[Update3: The Senate version of the health care bill, H.R.3590, passed on Dec 24. It does not contain the provision to extend Medicare coverage for immunosuppressive drugs.]

[Update4: A 2008 study published in Health Care Financing Review shows that adding coverage for immunosuppressive drugs after transplantation to Medicare would cost the government more than paying for dialysis. The analysis ignores social costs and tax effects.]

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