Payment for immunosuppression after organ transplantation

Dramatic improvements in organ transplantation have meant that a growing nu mber of patients must take expensive immunosuppressive medications for the rest of their lives, Currently, Medicare covers most transplantation proced ures in the United States, but ends coverage for outpatient immunosuppressi ve medications after 36 months. Evidence suggests that at least some patien ts have reduced immunosuppression and their transplants fail because they c annot afford these medication costs, In the years since the advent of effec tive immunosuppressive therapy, the US Congress has struggled with this iss ue, and in 1999 temporarily extended medication coverage for eligible patie nts (based on age and disability) by 8 months, However, a more permanent so lution is needed. We advocate that Medicare should cover the cost of all im munosuppressive therapy for all solid organ transplant recipients who canno t 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 for immunosuppression.