Kidney Transplants: Medicare Coverage of Immunosuppressive Drugs.

HEALTH Insurance Portability & Accountability Act; PATIENT Protection & Affordable Care Act; HEALTH insurance exchanges; HEALTH insurance; MEDICAL needs assessment

This document provides information on Medicare's coverage of immunosuppressive drugs for kidney transplant patients. It states that kidney transplants are the preferred treatment for end-stage renal disease and that over 27,000 kidney transplants were performed in the United States in 2023. Medicare coverage for these drugs ends 36 months after a transplant, but there are certain exceptions. The document explains the eligibility requirements, enrollment process, and coverage details of the Medicare immunosuppressive drug benefit. It emphasizes the importance of these drugs for preventing kidney rejection and maintaining the function of the transplanted kidney. The document also provides a list of different classes of immunosuppressive drugs used in kidney transplant patients and highlights the need for long-term adherence to the drug regimen. It mentions the potential side effects and risks associated with these drugs. The document concludes by explaining how kidney transplant patients can learn about the immunosuppressive drug benefit through Medicare outreach, CMS publications, and healthcare providers. It also mentions the costs associated with the benefit and the availability of Medicaid programs for eligible patients. According to the Government Accountability Office (GAO), as of February 2024, there were 104 patients enrolled in the Medicare immunosuppressive drug benefit for kidney transplant patients, with the majority located in Florida, Texas, and Ohio. Additionally, 146 patients enrolled and then disenrolled in the benefit from January 2023 to February 2024, with reasons including nonpayment of premiums, death, and invalid enrollment [Extracted from the article]

Copyright of GAO Reports is the property of U.S. Government Accountability Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)