Congress Must Extend Immunosuppressive Coverage To Kidney Transplant Patients

Wednesday offered the kidney and transplant community a rare opportunity to gather and hear from our nation’s leaders.

At a widely attended event, the Trump administration unveiled its Advancing American Kidney Health initiative, establishing new policy goals for at-home dialysis, removing disincentives for transplantation and increasing the number of available organs for transplant. Secretary Alex Azar has been spearheading a series of kidney initiatives since taking office at the Department of Health and Human Services.

The community celebrates any effort to support patients and to make transplantation more accessible, but what about those who have already received their new chance at life? During the Q&A, an attendee asked how the administration is planning to support kidney patients post-transplant. Azar responded, “the Trump administration is supporting legislation that would extend [Medicare’s coverage of immunosuppressive medications] beyond 36 months in Congress,”— a claim which, if legislation is ultimately enacted, will significantly improve the outcomes for thousands of kidney transplant recipients who face the financial burden of affording expensive medications for the rest of their lives.

As chief executive of CareDx, a company committed to improving the lives of organ transplant patients through non-invasive diagnostics, I have had the opportunity to watch the kidney transplant patient journey in action. Patients diagnosed with end-stage renal disease are covered by Medicare as a result of a commitment made by Congress in 1973.

Under the current arrangement, Medicare covers the cost of dialysis — to the tune of more than $85,000 per patient per year. After waiting an average of five to eight years on dialysis for a transplant, Medicare then covers the cost of the kidney transplant totaling more than $110,000.

Three years after a transplant, Medicare’s coverage of daily anti-rejection medications, which cost less than $3,000 per year and that kidney transplant recipients depend on for the rest of their lives, stops. They’re now required to find the funds to pay for it.

What happens to this vulnerable population? They spread out their medications to make it last longer; they face the financial burden as best as they can — deciding between food on the table or medication; they reject their donated gift and go back on dialysis; or, sadly, they die. The current Medicare policy cannot be justified morally, medically or economically.

The focus on kidney care from HHS is unprecedented. This current administration understands these issues firsthand: Azar’s own father was on dialysis and received a kidney transplant. Under Azar, HHS released two reports this May showing a potential cost savings of up to $300 million over 10 years by extending immunosuppressive medication coverage to these patients for the rest of their lives. 

Bipartisan legislation that would do just that has been introduced repeatedly since 2000, and it’s expected to be introduced again this summer. In years past, Congress struggled to find the funds to provide this coverage. 

However, that argument has now been muffled by the reports from HHS, and we believe momentum is on our side. HHS’ own analysis showing cost savings, along with alignment from the administration, provides a unique opportunity to pass this legislation this Congress. 

Along with a coalition of partners from the kidney and transplant community, CareDx has supported a national patient-centered campaign called Honor the Gift, which is focused on addressing the immunosuppressive medication coverage issue. With more than 7,000 signatories since the campaign launched this March, the community and the coalition have banded together to amplify our ask of Congress to do the right thing.

The policy initiatives outlined by Trump and Azar this week are laudable. But we cannot forget that transplantation is not a cure and that an estimated 375 patients per year lose their transplanted kidney due to a lack of immunosuppressive medication coverage.

I commend the administration for bringing this important issue into the fold once again — now it’s time for Congress to carry the torch across the finish line. Let’s make 2019 the year we finally pass comprehensive immunosuppressive medication coverage for kidney transplant patients.


Peter Maag is the CEO of CareDx Inc., a molecular diagnostics company that is committed to improving organ transplant patient outcomes through innovative solutions throughout the entire patient journey.

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