Secular Trends in the Cost of Immunosuppressants after Solid Organ Transplantation in the United States

Each year since 2009, more than 28,000 people have received organ transplants in the United States. This priceless gift comes with life-long costs of the critical immunosuppressant medications that prevent rejection. Although Medicare provides coverage for these drugs to kidney transplant recipients for three years following a transplant, many transplant recipients have difficulty affording the related out-of-pocket costs post-transplantation. Medicare Part D beneficiaries with resources just above the threshold to qualify for the Medicare low-income subsidy may experience the greatest financial strain. This can prevent some patients from filling necessary prescriptions, potentially leading to poor health outcomes and organ rejection.

Immunosuppressive medications are critical to reducing rejection and graft loss in transplant recipients. Substituting costly brand-name medications with therapeutically equivalent, less expensive generic medications is a potential solution to overcome the financial barrier and improve access and adherence to immunosuppressants.

Study findings published February 28, 2019, in the Clinical Journal of the American Society of Nephrology (CJASN) indicate a source of relief for these patients. Findings of a study conducted by Arbor Research Collaborative for Health show promise for transplant recipients.

Generic immunosuppressive medications first became available in 2009. Margaret E. Helmuth and her colleagues examined the potential cost savings of generic variations of two commonly prescribed immunosuppressants, tacrolimus and mycophenolate. For a large national sample of kidney, liver, and heart transplant recipients between 2008 and 2013, they compared the uptake of generics use by state. They determined that the introduction of generic medications in this class has resulted in substantial cost savings for transplant patients and Medicare.

Between 2008 and 2013:

• Individual patients not receiving the low-income subsidy saw a decline in average out-of-pocket payments by 63%-79% percent, or from $1,000 to $1,750 less depending on the organ type and drug.
• In the same period patients receiving the low-income subsidy saved from 24%-44 %, or $400 to $1,500 less per patient per year.
• Medicare Part D plans experienced a cost decrease of 48%-67% for the Medicare program, a range of $1,500 to $4,500 less per patient, per year in Part D plan payments.

Ms. Helmuth remarked, "The debate regarding universal coverage of immunosuppressive medications for transplant recipients has been ongoing for more than 30 years." On the relevance of the research, she added, "We believe that this research will help inform ongoing national discussions about the funding of post-transplant immunosuppressive medication coverage."