anti-rejection drugs and Medicare

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Re: [TRANSPLANT] anti-rejection drugs and MedicareThis is a real eye opener for the people that are in the medical field thatdeal with Transplants.> Subject: Re: [TRANSPLANT] anti-rejection drugs and Medicare>> Pedro Vergne-Marini: Medicare regulation threatens organ transplants> 06/10/2003>> By PEDRO VERGNE-MARINI>> As Congress begins to debate an expansion of Medicare drug coverage, organ> transplant patients in Texas and across the country are at risk of losing> access to therapies already covered by Medicare. A new regulation> implemented by the federal Centers for Medicare and Medicaid Services> earlier this year has drastically reduced Medicare reimbursement forcertain> innovative and, in some cases, lifesaving medications administered in the> hospital outpatient setting.>> On Jan. 1, the Centers for Medicare and Medicaid Services made changes to> Medicare reimbursement rates that may deny some patients access toimportant> therapies for organ transplants. Inadequate reimbursement rates for many> drugs in outpatient hospital settings now are forcing physicians, like me,> to make difficult decisions about how to provide elderly and disabled> patients suffering from cancer, diabetes and other life-threatening> conditions the best and most appropriate care.>> At the Methodist Medical Center, where I am the medical director for the> Kidney and Kidney/Pancreas Transplant Center, about 75 percent of our> transplant patients are Medicare beneficiaries. New therapies play a big> role in the 90 percent survival rate of renal transplants, but the> approximate cost of the transplant is very high - $80,000 per patient.> Federal reimbursement for transplant drugs - without which manytransplanted> organs would fail - is well below what the hospital pays to acquire the> drug.>> The Methodist Medical Center now is faced with the decision of whether to> admit transplant patients to the hospital for treatment at a markedly> increased cost. If forced to utilize less innovative therapies for kidney> treatment due to reimbursement cuts, 20 out of 100 patients could losetheir> transplants, be forced back onto dialysis or even risk death. Clearly, a> lack of access to outpatient care and innovative therapies could have a> devastating impact on Texas' Medicare transplant patients.>> The Centers for Medicare and Medicaid Services' actions are imperiling> access to medicines already covered by the program. Those actions are> forcing painful choices on doctors, hospitals and patients. Fifty-four> medicines are affected, including 14 for cancer and the treatment of> chemotherapy side effects, four for cardiovascular disease and emergencies> and four that help prevent rejection of transplanted organs.>> The Centers for Medicare and Medicaid Services is endangering access not> only to the medicines of today but also to those of tomorrow. Because> Medicare is the nation's largest health insurance program - coveringnearly> 40 million senior citizens and disabled patients - federal coverage and> reimbursement decisions have an impact on research and development.> According to the Tufts Center for the Study of Drug Development, it costs> $800 million and takes 10 to 15 years to develop a new drug. Researchers> simply won't be able to secure the resources to develop the nextgeneration> of medicines if reimbursement under Medicare is inadequate and> unpredictable.>> The Methodist Medical Center has a long history of providing its patients> with the most cutting-edge medical therapies available. In fact, we> performed the world's first successful heart-kidney-pancreas transplant in> 1992. The recent change in the Medicare regulations places Washington> squarely between the doctor and the patient.>> That is why Congress needs to repeal the Centers for Medicare and Medicaid> Services' rule as part of its efforts to add a drug benefit to theMedicare> program. For some patients, it is a matter of life and death.>>> Dr. Pedro Vergne-Marini is director of the transplantation and renaldisease> division at Methodist Medical Center in Dallas.>>>>>>> DallasNews.com> The Archives>>>>>>>>

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