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Policy Perspectives |

Payment for Immunosuppression After Organ Transplantation

Bertram L. Kasiske, MD; David Cohen, MD; Michael R. Lucey, MD; John F. Neylan, MD; for the American Society of Transplantation
JAMA. 2000;283(18):2445-2450. doi:10.1001/jama.283.18.2445.
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Dramatic improvements in organ transplantation have meant that a growing number of patients must take expensive immunosuppressive medications for the rest of their lives. Currently, Medicare covers most transplantation procedures in the United States, but ends coverage for outpatient immunosuppressive medications after 36 months. Evidence suggests that at least some patients have reduced immunosuppression and their transplants fail because they cannot afford these medication costs. In the years since the advent of effective immunosuppressive therapy, the US Congress has struggled with this issue, and in 1999 temporarily extended medication coverage for eligible patients (based on age and disability) by 8 months. However, a more permanent solution is needed. We advocate that Medicare should cover the cost of all immunosuppressive therapy for all solid organ transplant recipients who cannot afford to pay. A number of potentially cost-effective approaches could be taken, but, in any case, something must be done to ensure that transplants do not fail because recipients cannot pay for immunosuppression.

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Figure 1. Annual Medicare Expenditures Per End-Stage Renal Disease Patient, 1994
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Data are from the Health Care Financing Administration.7
Figure 2. Cumulative Savings in Renal Transplantation Expenditures Relative to Dialysis Expenditures by Donor Type, 1994
Graphic Jump Location
Data are from the Health Care Financing Administration (Paul Eggers, PhD, unpublished data, 1999). Savings are shown in constant 1994 dollars. Break-even points are periods after transplantation during which the cumulative expenditure for transplantation is equal to that of dialysis.

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