A story in the New York Times highlights a Medicare policy that is intended to save money, but is in reality quite wasteful. As of now, Medicare generally covers kidney transplants, which can routinely exceed $100,000. Following a transplant, patients must go on a regimen of drugs to prevent rejection of the kidney, and those drugs cost $1,000-$3,000 per month for the rest of the person’s life. Medicare, though, limits their coverage of those vital drugs to 36 months.
The 31-year-old patient in the NY Times article received her Medicare-covered kidney transplant and three years of her Medicare-covered drugs. But when the coverage ended, and she lost her job, she could no longer afford the medication and found herself back on dialysis for $10,000 per month — which, unbelievably, Medicare covers. Then she required another kidney transplant, for which Medicare again paid the six-figure bill. Of course, Medicare would have saved money on this patient if its policy didn’t cap the drug coverage at 36 months and she kept her initial transplant. And with kidneys in very short supply, it would have benefited the healthcare system not to have used up another organ.
Legislators have tried to change this policy, but the $100 million upfront cost of extending the drug coverage has prevented any real action. Focusing on the upfront cost is deceptive though. The costs of keeping patients on dialysis or providing new transplants are much higher. Considering that the yearly Medicare budget is over $20 billion, it seems ridiculous to squabble over $100 million — especially since that sum will save money down the line. The House healthcare bill does contain language that would extend this coverage, but it remains to be seen whether that will be in the Senate version. This policy has to change.
Read the NY Times story about this issue here.
