Author Affiliations: Department of Medicine, Hennepin County Medical Center, Minneapolis, Minn (Dr Kasiske); Department of Medicine, Columbia Presbyterian Medical Center, New York, NY (Dr Cohen); Division of Gastroenterology, University of Pennsylvania, Philadelphia (Dr Lucey); and Division of Nephrology, Emory University School of Medicine, Atlanta, Ga (Dr Neylan).
Policy Perspectives Section Editors: Robert
J. Blendon, ScD, Harvard School of Public Health, Boston, Mass; Drummond Rennie,
MD, Deputy Editor, JAMA.
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
Kasiske BL, Cohen D, Lucey MR, Neylan JF, for the American Society of Transplantation. Payment for Immunosuppression After Organ Transplantation. JAMA. 2000;283(18):2445–2450. doi:10.1001/jama.283.18.2445
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