Kidney disease – JustCare

Billions in Medicare savings from Medicare drug price negotiation by 2031

A new report from Nicole Rapfogel at the Center for American Progress (CAP) finds that the Inflation Reduction Act’s provision allowing Medicare to negotiate drug prices for its highest cost drugs will reduce drug spending by tens of thousands of dollars a year for millions of people with Medicare and save Medicare millions of dollars a year.

On September 1, 2024, the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, will announce the prices it has negotiated with pharmaceutical corporations on ten drugs that treat, among other things, diabetes, kidney disease, blood clots and heart failure. Beginning in January 2026, the cost of these drugs should drop considerably.

The ten drugs cost Medicare significantly more than other drugs it covers either because they have very high prices or because they are widely used. A total of nine million people currently use their Part D drug benefit to fill prescriptions for these drugs. These ten drugs represent roughly 20 percent of Medicare’s annual drug spending under Part D.

CAP projects that the price of one insulin product, NovoLog FlexPen will fall $30 a month and the price of one cancer drug, Imbruvica, will fall $6,548 a month. The price of Eliquis, which 3.5 million people with Medicare take, could drop by $123 a month.

Currently, Americans pay many times more than people in other wealthy nations for several of these drugs. For example, a dose of Stelara, another drug whose price Medicare is negotiating, which treats people with autoimmune conditions, costs $2,900 in the United Kingdom and $16,600 in the US. Moreover, Americans paid $6.5 billion in taxpayer dollars for the development of Stelara.

While Medicare is only negotiating the price of 10 drugs this year, by 2030 it will have negotiated the price of 80 drugs. CAP estimates that Medicare will save $25 billion as a result of drug price negotiation in the six years between 2026 and 2031.

Of course, the pharmaceutical corporations are trying to block these price negotiations in the courts, claiming that the government should not be interfering with the prices private corporations set. What they fail to say is that they developed these drugs with $11.7 billion in taxpayer dollars, The Lever reports. And, the pharmaceutical corporations made $70 billion on these drugs in 2022.

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February 27, 2024

For-profit dialysis care puts off transplants

Lizzie Presser reports for Pro Publica on how the corporate for-profit health care system is rigged against Black Americans and puts shareholder interests ahead of patients’ care needs. Presser looks specifically at how Black Americans with chronic kidney disease are three to four times likelier to reach kidney failure than white Americans, even though they suffer from similar rates of disease.

Among other health inequities, Black Americans are twice as likely to develop diabetes than white Americans and that makes it more likely that their kids will have diabetes. Black Americans are also more likely to be uninsured or underinsured, and to struggle to pay for their medications. They are more likely to suffer from hypertension and diabetes, which are primary drivers of kidney disease. And, the formula for determining whether kidneys are functioning factors in race in a way that undermines Black Americans’ ability to get needed care.

You might not know it, but the US has Medicare for all with kidney failure. Everyone with kidney failure is eligible for Medicare. Medicare covers all the medically necessary care that people with kidney failure need.

Unfortunately, treating kidney failure has become a big for-profit business. DaVita and Fresenius are the two biggest corporate players with 70% of the market. And, their incentive is not to refer their patients for transplants. They profit the longer their patients remain on dialysis.

Put differently, if you go to a for-profit facility for dialysis, you are less likely to get on a waiting list for a transplant. The incentives are not there for the facility to make the referral. They lose patients and revenues with each person who gets a transplant.

But, dialysis facilities are the gateway to a kidney transplant. Patients tend to look to the people who care for them at these facilities for help getting referrals for transplants. Black patients fare worse than white patients.

Black Americans are 18 percent less likely to get care from a nephrologist in the year before getting dialysis, in part because they are less likely to be insured. As a consequence, one specialist says mortality rates are seven times higher for Black patients than white patients. If you have diabetes and do not have good access to specialty care, you are likely not to get drugs that can ward off kidney failure. You are more likely to go without a transplant.

Patients with kidney failure benefit greatly from kidney transplants. There are not enough living donors, so many people must rely on kidneys from people who have just died. Demand for kidneys far exceeds supply.

The Centers for Medicare and Medicaid Services (CMS) has laid out specific protocols for dialysis centers to notify their patients about transplant options. But providers like DaVita are not following guidelines, and CMS is not enforcing them. And, it does not track or publicize rates of referrals from different dialysis centers, nor does it penalize centers that have low referral rates. There are also no rules that ensure equal access to referrals and evaluations for patients. This must change.

Here’s more from Just Care:

December 21, 2020

PPIs found to increase risk of kidney failure

Routine use of proton pump inhibitors, common over-the-counter medications used to treat acid reflux, can increase the risk of kidney failure four-fold.

Researchers examined health data on more than 190,000 patients over a 15-year period in a retrospective study. None of the patients had existing kidney disease at the start. Researchers compared patients who were eventually given a PPI and those who weren’t ever given one. Common PPIs include Prevacid (lansoprazole), Prilosec (omeprazole) and Nexium (esomeprazole).

Results, published in Pharmacotherapy, found that those on a PPI had a 20% increased risk of chronic kidney disease compared with those not on the drug. In addition, those on a PPI were four times as likely to experience kidney failure. The study authors noted that the risks were highest in those 65 and older.

Although PPIs are only meant for short-term use, overuse of the medications are as high as 70% of patients.

Lead author David Jacobs, PharmD, PhD, assistant professor of pharmacy practice at the University of Buffalo School of Pharmacy and Pharmaceutical Sciences, noted that doctors need to be educated on the dangers of overuse of PPIs and deprescribing initiatives developed.

Last month, a study that analyzed adverse events reports sent to the FDA found that PPIs were associated with an increased risk of kidney disease.

This story first appeared on Medshadow.org.

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April 2, 2019

Kidney voucher program launched and catching on

Fran Kritz of Kaiser News reports on how a retired Superior Court judge, Howard Broadman, came up with a creative idea for gifting a kidney to his grandson. His vision of a kidney voucher program has been launched and is catching on.

Judge Broadman knew his kidney was a perfect match for his grandson, born with only one only partially functional kidney. But, his grandson did not have an immediate need for a new kidney. So, he found a way to gift his grandson a kidney if and when it was needed. Through the kidney voucher program, he could give his kidney away now in exchange for a voucher entitling his grandson to a kidney at some future date.

The kidney voucher is not a guarantee that there will be a kidney match down the road when his grandson needs it. But, it increases the chances there will be. And, immediately, it helps someone in need of a kidney.

The National Kidney Registry administers the voucher program. And, 30 U.S. hospitals now participate in the program. The voucher can only be used by the person to whom it is given.

The voucher program should not be confused with a kidney chain. A kidney chain helps people who need a kidney urgently. A group of people donate their kidneys to a loved one indirectly. Their kidneys are not perfect matches for their loved ones, so they donate theirs to someone for whom their kidney is a perfect match, and someone else whose kidney is a perfect match donates to their loved one.

Each year 4,500 people die because they can’t obtain a kidney. And, 93,000 people are waiting for a kidney, most of whom are on dialysis.

Here’s more from Just Care:

September 19, 2017

For-profit kidney dialysis: Profits before people

In a recent episode of Last Week Tonight, John Oliver takes on the kidney dialysis industry, particularly DaVita, the for-profit company that controls a large piece of the kidney dialysis business in the U.S. Oliver exposes the various ways for-profit kidney dialysis companies put profits before people, compromising people’s health.

For background, End Stage Renal Disease (ESRD) or kidney failure is the 9th leading cause of death in the U.S. Today, 500,000 adults have ESRD; 7,000 outpatient clinics provide dialysis. Another 17 percent of the adult population has chronic kidney disease, which can turn into kidney failure, if not detected and properly treated, People with kidney failure need dialysis–a three to four-hour process, three times a week, by which people’s blood is withdrawn, cleaned and returned to their body–to stay alive.

The number of people needing dialysis has grown substantially since 1972, when Richard Nixon expanded Medicare to cover anyone with ESRD. At that time 10,000 people had ESRD.

Oliver makes a compelling case that DaVita and other for-profit dialysis companies are not providing people with ESRD the care they need. For example, Oliver reveals that at least some DaVita employees appear to promote dialysis over kidney transplants. Yet, dialysis is not a long-term solution for people with ESRD, whose risk of death increases each year. They need a kidney transplant, if they are eligible for one, which can prolong their lives significantly.

Oliver also highlights DaVita’s poor infection control practices, alleged improper payments to doctors to refer patients to DaVita and overcharges to Medicare for drugs. (Seven years ago, Pro Publica reported unsafe and unsanitary conditions in many dialysis facilities.) While denying any wrongdoing, DaVita settled a lawsuit alleging that DaVita gave kickbacks to doctors for referring them patients, for $389 million. Again denying any wrongdoing, DaVita settled a whistleblower suit claiming that DaVita overcharged Medicare for drugs, for up to $495 million.

DaVita and one other for-profit company, Fresenius (which denied any wrongdoing but agreed to a $250 million settlement of a lawsuit alleging that it caused patients fatal heart problems and strokes) own seven in 10 of the dialysis clinics in the U.S. It’s hard to understand how Medicare gives many of these clinics a four-star rating for the quality of their patient care.

The cost of dialysis is enormous, 1 percent of the federal budget. In 2013, Medicare spent $31 billion on dialysis treatments for people with kidney failure. DaVita posted $789 million in profits in 2016.

Medicare needs to do a better job of overseeing DaVita, Fresenius and other for-profit dialysis companies to ensure, among other things, that they help patients understand the value of a kidney transplant over dialysis, and provide good quality care to their patients.

Here’s more from Just Care:

May 23, 2017

Many older adults not taking blood pressure drugs as prescribed

A new CDC report reveals that some seven out of ten older adults have high blood pressure. And, half of them do not have their blood pressure under control. Five million older adults are not complying with their Medicare Part D blood pressure prescriptions. The risks of heart disease, stroke, kidney disease and early death are serious.

Taking blood pressure drugs as directed is important to protect the heart, brain and kidneys. But, according to the CDC, one in four older adults with Medicare Part D prescription drug coverage are not doing so. Some are skipping doses. Others are not taking them at all. Underuse of drugs is associated with higher risk of death and health complications.

There are many reasons people do not comply with their blood pressure treatment regimens, including high cost, failure to fill prescriptions, assumption that they don’t need to because they don’t experience symptoms, side effects, forgetfulness and complexity.

The CDC found that four in ten older Native Americans did not take blood pressure drugs as prescribed, and almost as many African Americans (35 percent) and Hispanics (34 percent).

The CDC is encouraging people to use blood pressure monitors at home to track their blood pressure. (Just Care offers these ten tips for taking your blood pressure at home.) The CDC also suggests people take their medications while doing other routine activities such as brushing their teeth, as a way to better ensure medication compliance. Weekly pill boxes and apps also can be used as reminders of when to take medicine.

Here’s more from Just Care:

September 21, 2016

Death rate up in U.S., though fewer dying of cancer

New CDC data show that the death rate is up in the U.S in 2015 to almost 2.6 million. The number of deaths (age-adjusted) rose from 723.2 deaths in 2014 to 729.5 per 100,000 last year. With the exception of the death rate for cancer, which has fallen slightly, death rates for most other chronic conditions are rising. Still, there are many more births—4 million births in the U.S. in 2014, up 1 percent from 2013—than deaths.

Here’s some age-adjusted data:

More older adults are dying from falls, up from 58.7 to 59.8 deaths per 100,000
More people are dying from suicides, stroke, emphysema, drug overdoses and Alzheimer’s disease
- Stroke: Up from 36.4 to 37.4 deaths per 100,000
- Suicides: Up from 12.7 to 13.1 deaths per 100,000
- Emphysema and chronic bronchitis: Up from 40.1 to 41.3 deaths per 100,000
- Drug overdose: Up from 14.1 to 15.2 deaths per 100,000
- Alzheimer’s disease: Up from 25.4 to 29.2 deaths per 100,000
Rates of death linked to heart disease, diabetes and kidney disease have not changed
- Heart disease: Only slightly up from 166.7 to 167.1 deaths per 100,000
- Diabetes: Only slightly up from 20.9 to 21.1 deaths per 100,000
- Kidney disease: Very slightly up from 13.2 to 13.3 deaths per 100,000
Fewer people are dying from cancer, down from 160.9 to 157.9 deaths per 100,000

Here’s more from Just Care:

June 9, 2016

Kidney disease prevalent; many unaware

Kidney disease is prevalent in the U.S, posing huge health risks at enormous cost, according to a recent report by Rajesh Balkrishnan. In 2013, Medicare spent $81 billion dollars treating people with kidney failure (End-Stage Renal Disease) and chronic kidney disease. Fourteen percent of Americans, some 26 million adults, suffer from chronic kidney disease–loss of kidney function–and most are unaware.

People with diabetes and high blood pressure are most likely to get kidney disease. People with chronic kidney disease need a range of costly services. Twenty percent of Medicare spending on people over 65 is for treatment of chronic kidney disease.

Drugs alone typically cost $3,675 a patient under Medicare Part D or 46 percent more than other people with Medicare, whose average Part D costs are $2, 509. People with kidney failure average $6,673 in Part D drug costs, 2.6 times what other people with Medicare spend. And dialysis patients average $7,142 in drug costs.

People with Medicare eligible for a low-income program that helps pay the drug coinsurance or copays only spend one or two percent of total costs out of pocket. But, people who must pay the full share of out-of-pocket costs end up with large bills amounting to about 30 percent of total costs.

Medicare now covers a diabetes prevention program.

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April 10, 2016

Tag: Kidney disease