Healthcare Reform and Your Transplant
As you plan for your transplant, it's a good idea to also plan how you will cover the costs of your transplant medications (also called immunosuppressants).1 Taking these medications exactly as your transplant team recommends is critical to protecting your transplanted organ. It is essential that you understand what your insurance covers, so you can be better prepared for the time when you need to access these important medications, for as long as you need them.
What impact will healthcare reform have on my medication coverage?
The goal of healthcare reform, also referred to as the Patient Protection and Affordable Care Act, is to ensure that all Americans have access to quality, affordable healthcare.2 Since it was passed in 2010, there have been a number of changes to medication coverage that you may need to be aware of, with more changes occurring each year until 2020.
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Medicaid: expanded eligibility
In some states, Medicaid may be expanded to include people with incomes up to 133% of the federal poverty level. This means that people who may not have been eligible for Medicaid in the past may now be eligible. Note that Medicaid coverage is state specific and you will need to check your state Medicaid eligibility requirements. That said, look for potential changes to your state's Medicaid coverage to take place by 2014.3
To find out more about Medicaid and eligibility requirements, visit www.cms.gov.
Medicare: closing of the "donut hole"
By the year 2020, Medicare Part D beneficiaries will no longer have to worry about the donut hole, as it will no longer exist.4 That may feel like a long time to wait, but know that valuable steps have already been taken to reduce the burden of this coverage gap1,2:
Medicare: efforts to extend coverage of immunosuppressants
As it currently stands, Medicare offers lifetime coverage for immunosuppressants, but only under specific circumstances, such as having your transplant at a Medicare-approved hospital, and being age 65 years or older and/or being disabled.5 However, for reasons that cannot be easily explained, Medicare coverage based solely on end-stage renal disease ends 36 months after transplantation. The healthcare reform bill initially contained language that would do away with this limitation, but the language was taken out before it passed into law. The National Kidney Foundation, the American Society of Transplant Surgeons and key members of Congress remain committed to having this limitation removed for the sole purpose of ensuring that kidney transplant recipients continue to receive coverage for the medications critical to their health.4,6
The Affordable Care Act and private insurance
If you have private insurance, here are a few ways you, too, may be affected by the healthcare reform2,7:
Every plan is different, so be sure to ask your insurance provider about how these changes might affect your individual plan.
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If you are struggling to pay for your medications, there are resources beyond government programs or private insurance that may be available to you. These include programs offered by pharmaceutical companies. For financial assistance on Astellas medications, such as Prograf® (tacrolimus) capsules, you can enroll in the Prograf: Value Card* program or visit www.astellasaccess.com to explore your medication coverage options.
 As I always point out, the information I have received from The Transplant Experience has been completely invaluable! Remember, as a patient, the more you know, the less fear and uncertainty you will have; and your ability to cope with everything will be far greater. So read, study, learn, ask questions...really understand the process. This approach has helped me far more than I can adequately convey! ScottW | ||||||||||||||
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