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Kidney360
Kidney360
KIDNEY
Kidney360
Kidney360
2641-7650
American Society of Nephrology

39207892
K360-2024-000471
10.34067/KID.0000000000000502
00018
3
Patient Perspective
Med Money
The Effects of Prescription Cost on Patients with Kidney Disease
Smith LaMorgan
Nephrology, UAB Hospital, Birmingham, Alabama
Correspondence: Ms. LaMorgan Smith, email: las332016@gmail.com
8 2024
29 8 2024
5 8 11911192
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

chronic dialysis
CKD
chronic kidney failure
dialysis
ESKD
kidney transplantation
OPEN-ACCESSTRUE
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pmcWith all of the challenges that patients with kidney disease face, you would think getting medications would be the least of their worries. Think again. The responsibility of having to manage kidney disease whether as a dialysis patient or as a kidney transplant recipient can be and is overwhelming at times. There are physical, mental, emotional, and even spiritual obstacles that patients with kidney disease must face and do our best to either accept or overcome. Adding financial responsibility for many of us is scary and even more challenging than everything else.

The great thing about having kidney disease in the 21st century is that many improvements and advancements in medicine, as it pertains to kidney health and disease prevention and management, have made great strides and improvements for patient outcomes and even many patients' quality of life. Although these things are extremely commendable, the ever-increasing costs of medications and care cause many patients and their family's severe financial distress.

Managing kidney disease and undergoing kidney transplantation are life-altering experiences that come with significant financial challenges. Although medical advancements have improved outcomes and quality of life for patients, the rising costs of medications pose a substantial burden. In this article, we explore the financial implications of medication expenses for individuals with kidney disease and transplant recipients.

When we discuss the cost of dialysis care, there are many expenses outside of maintenance medication. According to the United States Renal Data System, the average cost of hemodialysis care is $72,000.00. For peritoneal care, it averages about $53,000.00.1 That does not include the cost of vascular surgery for hemodialysis access and catheter placement for peritoneal access. There are other associated costs, such as dialysis supplies, dialysis solution for peritoneal dialysis, transportation, injectable medications, laboratories, and others not limited to copays, deductibles, insurance premiums, and more.

As a patient undergoing kidney transplant, there are so many components of our care. Along with treatment and lifestyle changes, medication is a key component of our quality of life. Medications aid in maintaining BP and preventing anemia and bone loss. It also helps in the delay of disease and/or organ rejection.

Although necessary and life sustaining, the cost can place patients in an either/or situation. For example, “Do I pay my mortgage, or do I get my antirejection this month?” “I just got my medication, how will I feed my family?” These are real questions of real patients. Having to ask those questions can cause patients to feel stressed and even depressed. Depression can cause patients to become careless with their health from skipping dialysis treatments to not taking life-preserving medications, which can cause hospitalization or even organ rejection that are additional costs.

I know that some people may say “Well, you get Medicare!” As true as that is, even with Medicare, the costs can still be burdensome, especially if the patient has comorbidities such as heart disease, diabetes, or neurological disease. As a dialysis patient, you automatically qualify for Medicare. However, there is a waiting period. If you only have Medicare, 20% of the remaining cost of care would be assessed by the patient. Although 20% patient responsibility may not seem like much on $72,000.00, for 3–5 or more years, it is quite a bit. That is just the estimated cost of dialysis treatment alone.

Patients also qualify for disability benefits, which is a wonderful thing. However, sometimes that money is a patient's only source of income, which presents challenges. If you are able to work, you possibly have the opportunity to obtain insurance through an employer. That can be both a blessing and a curse. Because on one hand, you are able to get your medications at a less expensive rate, but one of the two things can happen.

Your insurance can potentially be nearly unaffordable for transplant patients, or the insurance may not cover your antirejection medication, which still puts the patient in a bind in some cases. In my own experience, I have had insurance that did not cover my antirejection medication, of which I had to pay out-of-pocket cost. The cost was nearly as much as my biweekly insurance premium.

For patient undergoing kidney transplant, the struggle begins 3 years after you have successfully maintained your transplant2 because you are no longer considered disabled. If you have not prepared for that time, especially if you do not plan to go back to dialysis, it is like starting over as an adult. You will have the option to get a Medicare Advantage plan. As great as they are, some of them do not cover life-saving medications for kidney transplant patients.

All is not lost; there are options that can help to relieve some of the burdens of prescription costs for patients. Some medications can be bought in generic form for reduced cost; most hospitals and/or clinics have financial assistance programs for patients; and there are online discount prescriptions programs such as Good RX that provides prescriptions at discount prices. Another wonderful way that would ease the financial burden of prescription cost really starts on Capitol Hill. Our Congress and other policymakers can put their best foot forward when it comes to the reformation and reconstruction of health care; there have already been improvements made, but it is still a long road ahead.

The best advice that I can really give is to take care of yourself. Work with your care team to make sure that you stay on the right path to a better quality of life. Please make sure that you keep your insurance active by every means necessary. DO NOT let your coverage lapse. I was in between employers, and it happened to me. I was without insurance for 6 months as a patient undergoing kidney transplant, which is potentially fatal. However, thanks to the Lord, my kidney transplant coordinator, and social worker, they were able to help me with affording my medications until my insurance started with my new job.

Just know, if this happens to you, they will potentially only help with the antirejection medication. Your other prescriptions, if any, will go through your primary physician. I was able to use an online prescription discount program until I received insurance from my employer. If you are curious, when I went to my kidney transplant checkup, everything was perfectly fine, and I am now on my way to 1-year visits.

Yes, the cost of being a patient with kidney disease is overwhelming at times; however, regarding the policy improvements our government makes in terms of health care, there is still a possibility of light at the end of such a dark tunnel. Until then, there are still options that can somewhat lessen the financial struggle that some patients have as they continue to strive for a better life.

Acknowledgments

The content of this article reflects the personal experience and views of the author and should not be considered medical advice or recommendation. The content does not reflect the views or opinions of the American Society of Nephrology (ASN) or Kidney360. Responsibility for the information and views expressed herein lies entirely with the author.

Disclosures

Disclosure forms, as provided by each author, are available with the online version of the article at http://links.lww.com/KN9/A560.

Funding

None.

Author Contributions

Writing – original draft: LaMorgan Smith.
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References

1. Cost Helper Health. How Much Does Dialysis Cost?. CostHelper; 2024. Accessed June 10, 2024. https://health.costhelper.com/dialysis.html#:∼:text=For%20patients%20not%20covered%20by%20health%20insurance%2C%20a,year%20for%20the%20typical%20three%20treatments%20per%20week
2. CMS. End-Stage Renal Disease (ESRD); 2023. Accessed June 10, 2024. https://www.cms.gov/medicare/coordination-benefits-recovery/overview/end-stage-renal-disease-esrd
