Abstract: FR-PO1174
Medicare's Kidney Transplantation Immunosuppression Drug Coverage: A Well-Intentioned Policy with Little Impact
Session Information
- Transplantation: Clinical - Transplant Access, Recipient Evaluation, Living Donors, Pregnancy, and More
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Lin, Eugene, University of Southern California Keck School of Medicine, Los Angeles, California, United States
- Lung, Khristina I., University of Southern California, Los Angeles, California, United States
- Meyer, Rachel, American Society of Nephrology, Washington, District of Columbia, United States
- Mohan, Sumit, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
Background
Although dialysis confers Medicare eligibility, Medicare coverage sunsets 36 months post-kidney transplant, unless recipients have another qualifier (e.g., age). Losing access to immunosuppression could result in premature returns to dialysis and, ironically, resumed Medicare eligibility. In 2023, Medicare extended Part B immunosuppressive drug (PBID) coverage to patients losing Medicare 36 months post-transplant. However, PBID excludes non-immunosuppression healthcare benefits, even though transplant recipients have important healthcare needs beyond immunosuppression.
Methods
From the Chronic Conditions Warehouse’s Virtual Research Data Center, we identified 100% of fee-for-service Medicare and Medicare Advantage kidney transplants from 2020-2022. Using the Aalen-Johansen estimator, we tracked the probability of different insurance states over time (full Medicare benefits, PBID, loss of Medicare benefits, or death), with 12/31/2025, the last day of follow-up. We quantified total PBID spending from Medicare claims.
Results
We identified 73,036 adult, Medicare-enrolled kidney transplant recipients from 1/1/2020, to 12/31/2022. By month 37 post-transplant, 82% of survivors retained Medicare coverage and 18% (n=9,105) lost Medicare benefits (Figure). Only 282 (<1%) individuals ever obtained PBID. Of all kidney transplant recipients (including transplants before 2020), only 455 patients ever enrolled in PBID from 2023-2025. From this group, 63% disenrolled from PBID within a month, and only 39 enrollees retained PBID for at least 12 months. Eighteen individuals acquired full Medicare benefits, while most obtained non-Medicare coverage after 12 months. In total, 459 PBID enrollees had 1192 paid claims (> $0), adding up to $82,390 of Medicare spending, or $179 per enrollee.
Conclusion
PBID is ineffective and rarely maintained by patients. A program expanding healthcare coverage beyond immunosuppression would likely improve access to long-term kidney transplant care.
Acknowledgment
Data for this research came from the Centers for Medicare & Medicaid Services' (CMS') Chronic Conditions Warehouse (CCW) Virtual Research Data Center (VRDC). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the U.S. government.
Insurance Coverage Post-Transplant
Funding
- NIDDK Support