By Marc Beuttler

The Obama administration has decided not to revoke an insurance coverage mandate for transplant recipients. The life-preserving medication these patients require can cost more than $2,000 a month, and if the proposal to relax insurance coverage for transplant recipients had been adopted, drug costs would have jumped for vulnerable populations.

Many people already cannot afford what they currently pay for life-preserving drugs. Since 2006, a federal guarantee requires all private insurance plans that provide prescription benefits for the elderly and the disabled on Medicare must also cover “all or substantially all” medications in three categories: antidepressants, antipsychotics and immunosuppressants (to prevent graft-host disease and rejection of transplanted organs).

The original impetus to drop this requirement was for cost. It was thought that the increase in the availability of generic drugs could allow these regulations to be relaxed and still allow people to access life-preserving medication while saving taxpayers’ money. However, many lawmakers disagreed, and given the complexities, the recent proposal was put on hold to be revisited in the future.

The price and availability of prescription drugs is necessary to maintain healthcare, most especially for those transplant recipients who need daily, life-preserving medication. One important critique of the way such insurance programs are managed is that those who oversee them do not understand the transplant community or its needs. The transplant community needs more voice and visibility to ensure that insurance mandates are handled correctly in the future.

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