TRIO Legislative Action News
Update of December 14, 2019
Legislative activities around the US
The legislative and lobbying front continues to be a very active place in the world of transplantation. There are major initiatives in pharmaceutical coverage, Medicare plans, the kidney health crisis, and even a review of NOTA, the National Organ Transplant Act of 1984. NOTA was the Congressional act that created the transplant system in the United States, along with its governing laws and principles.
The Partnership for Part D Access has been the watchdog to make sure that recipients have full capabilities to choose the correct immunosuppressive regime that works for each individual.
Last Spring, Medicare proposed changes that would have limited access to medications under the protected classes, including immunosuppressants. Fortunately, the grassroots engagement of patients from across the country, including the transplant community, forced Medicare not to make the changes. This is good news for the transplant community; however, the Partnership expects that the administration could try to make changes to the policy again in 2020.
It is important for patients to remain vigilant and engaged. You can get more information about the Partnership at its website, www.partdpartnership.org.
In addition to the efforts of the Partnership for Part D Access, there is another group, CareDX, focusing on the severe limitations of Medicare coverage for immunosuppression. Right now, Medicare payments only last for 36 months once immunosuppression starts for patients enrolled in ESRD. If you are covered by Medicare Part B for your immunosuppression, then your coverage continues past 36 months. This group has worked tirelessly over the past year and has succeeded in getting the Congress to focus its attention on this issue. The Coalition of partners in the HonorTheGift coalition expect a bill to be introduced into the House and Senate, with bi-partisan support, to correct this serious coverage issue. Learn more about the efforts of this group at www.honorthegift.org.
Last Spring, a group of clinicians formed an organization to help with research and publicity of the liver diseases called NASH/NAFLD. This stands for non-alchoholic steatotopic hepatitis/non-alcoholic fatty liver disease. This is a class of liver ailments that can lead to cirrhosis and even liver transplantation. The group is working on a draft of legislation that would significantly highlight the need for attention to these ailments and fund major efforts in research and prevention. More information about this group and these diseases can be found at www.nashalliance.org.
The major announcement from the Executive Branch took place last July 10th with a push to increase public awareness on kidney disease, treatment, and transplantation. A special edition of the TRIO E-Newsletter on July 15, 2019 covered the announcement. Since that time, a group of individuals, including economists, living donors, and patient advocates, have been working with the Executive Branch to improve significantly the benefits of the National Living Donor Assistance Center (NLDAC). The Center was created to help subsidize the costs of citizens willing to participate as a good Samaritan kidney donors. You can find out more information about the NLDAC at its website, www.livingdonorassistance.org.
All of these efforts on behalf of transplant recipients and the backlog waitlist of those hoping for a gift need your help. There is grassroots effort going on in each of these groups. These groups are looking for you to add your time and your voice to their efforts. Reach out directly to any of them or get in touch with Rodger Goodacre, at This email address is being protected from spambots. You need JavaScript enabled to view it., or Ike Copperman, at This email address is being protected from spambots. You need JavaScript enabled to view it., for more information.
Another way you can stay informed is to appoint a legislative watchdog in your chapter. We will make sure to keep your watchdog informed about activities in legislation and lobbying.
Update of November 14, 2019:
Subject:Part D Partnership Call of Nov 13
The Partnership for Part D Access (Partnership) held its monthly call on November 13, 2019. A list of attendees is provided below.
H.R. 3 Update
Andy Rosenberg and Alex DelPizzo of Thorn Run Partners provided Partnership members with an update on the latest developments on Speaker Nancy Pelosi’s (D-CA) drug pricing bill. At a markup of the bill last month, Republicans on the Energy and Commerce Committee filed an amendment that would allow plans to exclude drugs within the protected classes if their price increases faster than inflation. Alex explained that Partnership reached out to Committee members and allies of the six protected classes policy to discuss the issue, expressing concerns about further injecting the protected classes into the drug pricing debate and oppose any effort to include such provisions in H.R. 3. While Committee staff largely agreed with Partnership’s decision, Alex noted that Republicans have been frustrated with patient groups for refusing to come out with a position against the sweeping drug pricing proposal. The amendment was not officially offered during the markup, but the Partnership will continue to be diligent and keep a close eye on the drug pricing debate following this development.
GAO Update
Andy went on to provide an update on the Partnership’s efforts to produce a study on the protected classes policy from the Government Accountability Office (GAO). As Catherine previously mentioned, there are two approaches are under consideration. The first would pursue research similar to what Avalere produced earlier this year with the goal of refuting arguments made by health plans that ascertain the plan is required to cover every medication, as well as highlight plan use of financial mechanisms — including fail first and prior authorization — to drive patients toward the plan’s preferred medication. The other study would analyze data on the Part D appeals and grievance process — a process that was touted as a safeguard by the Trump administration and other opponents of the current six protected classes policy — to determine how often and effective this process is for patients requiring a medication from a protected class.
Andy reported that Senator Susan Collins (R-ME) has agreed to lead a letter to the GAO through the Senate Special Committee on Aging. He noted that the Partnership is still waiting on confirmation from Aging Committee Ranking Member Bob Casey’s (D-PA) office that he will join Sen. Collins on the letter. Other Senators that are interested in joining the letter to the GAO include Sens. Martha McSally (R-AZ), Kyrsten Sinema (D-AZ), Marco Rubio (R-FL), and Jacky Rosen (D-NV). Andy encouraged any Partnership members who have relationships with these offices to reach out to Catherine if you are able to help facilitate outreach. Arnie Clayman of American Society of Consultant Pharmacists said that his organization may be able to help in this regard.
Legislative Option
Andy also mentioned that the Partnership has begun working to formalize potential legislative option that would combat future changes to Medicare’s six protected classes. While the group has previously explored options that would remove the Secretary of Health and Human Services’ (HHS) ability to change the six protected classes, Andy explained that the new approach would create “guardrails” around the Secretary’s authority by requiring that HHS demonstrate that the proposed changes would not impact patient access, nor create increased costs in Medicare Part A, Part B, or Medicaid. Andy emphasized that this option is still a work in progress, and encouraged members to reach out to the team at Thorn Run with any questions, comments, or suggestions.
Meeting Participants
· Diana Felner, Tourette Society of America
Ike Copperman, TSO
Kim Czubaruk Cancer Support Community
Roger Goodacre, Transplant Recipients International Organization
Lisabeth Iglesias, Lupus and Allied Diseases Association
Debbie Plotnick, Mental Health America
Arnie Clayman, American Society of Consultant Pharmacists
Bill Franco, Acadia
Hannah Baer, Acadia
Nick Rebholz, Johnson & Johnson
Bela Sastry, Sunovian
Theresa Jolivette, Sunovian
Dan Harder, Allergan
Andy Rosenberg, Thorn Run Partners
Alex DelPizzo, Thorn Run Partners
Prior to 2000, immunosuppressive drug coverage was limited to 36 months following a transplant for all kidney transplant recipients. In the Beneficiary Improvement and Protection Act of 2000, Congress eliminated the 36-month limit for transplant recipients who had a Medicare transplant, if they are eligible for Medicare based on age or disability.
Recipients would pay the individual portion of the Part B premium, and Medicare would be extended beyond 36 months only for recipients who lack other health care coverage. All other health care needs for transplant recipients who are not Medicare aged or disabled would remain subject to the current ESRD 36-month coverage limit.
Organ transplant recipients must take immunosuppressive medications for the life of the transplant to help prevent the body from rejecting the organ. HR 1458 would extend immunosuppressive drug coverage for Medicare-eligible kidney transplant recipients for the life of the transplant. They would not necessarily have access to other parts of Medicare, but this would ensure that they could retain Part B access to these expensive medications. Currently, Medicare pays for most kidney transplants but covers medications for only 36 months post-transplant as part of the Medicare ESRD benefit.
Many kidney patients lose access to Immunosuppressive medications. In a study of 1,000 kidney transplant recipients, graft loss more than doubled when Medicare coverage for anti-rejection drugs ended. This is associated with a significant cost to Medicare and the taxpayers because patients who lose transplanted kidneys must return to dialysis or seek another transplant. Furthermore, once a transplanted kidney no longer works, the patient’s risk for death is nine times as large!
In a survey by the United Network for Organ Sharing and the American Society of Transplantation, 70% of transplant centers report that patients have extreme or very serious problems paying for their medications, and 68% of kidney transplant deaths or graft failures are possibly the result of lack of access to anti-rejection medications.
According to the most recent report from the United States Renal Data System, Medicare spends an average of $77,000 per year indefinitely dialyzing patients with kidney failure. However, it spends $106,000 the first year after transplant and an average of $17,000 per year thereafter, including the cost of Immunosuppressive medications. It thus makes financial sense for Medicare to remove the 36-month coverage limitation for Immunosuppressive medications.
In the most recent report, we discussed an important bill introduced in the United States Senate. Today, I'm pleased to announce that a companion bill has been introduced in the House of Representatives with bipartisan support and co-sponsorship. In the House of Representatives, Michael C. Burgess, M.D. (R–Texas) and Congressman Ron Kind (D–Wisconsin) introduced the Immunosuppressive Drug Coverage for Kidney Transplant Patients Act. This legislation, H.R. 2969 will allow individuals who are eligible for immunosuppressive drugs under Medicare Part B to continue to receive their vital treatment past the 36-month cutoff. Without these medications, transplant recipients are at risk to lose their transplanted kidneys which has too often happened.
Since 1972, Medicare has covered people with irreversible kidney failure, or end-stage renal disease (ESRD). There is no Medicare time limit for a dialysis patient. However, kidney transplant recipients lose their Medicare coverage 36 months after a transplant. Extending immunosuppressive coverage beyond the 36-month limit would decrease the risk of organ failure due to patients neglecting to take the immunosuppressants following loss of immunosuppressive coverage. Furthermore, it has been found that transplant recipients have a higher quality of life, and are more likely to return to work than dialysis patients.
Take action now:
Reach out to your legislators and express your support of the important legislation above. The life you save may be yours or that of others around the country with your actions.
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