Abstract
Transplant immunosuppressants are often used off-label because of insufficient randomized prospective trial data to achieve organ-specific US Food and Drug Administration (FDA) approval. Transplant recipients who rely on Medicare Part D for immunosuppressant drug coverage are vulnerable to coverage denial for off-label prescriptions, unless use is supported by Centers for Medicare & Medicaid Services (CMS)–approved compendia. An integrated dataset including national transplant registry data and 3 years of dispensed pharmacy records was used to identify the prevalence of immunosuppression use that is both off-label and not supported by CMS-approved compendia. Numbers of potentially vulnerable transplant recipients were identified. Off-label and off-compendia immunosuppression regimens are frequently prescribed (3-year mean: lung 66.5%, intestine 34.2%, pancreas 33.4%, heart 21.8%, liver 16.5%, kidney 0%). The annual retail cost of these at-risk medications exceeds $30 million. This population-based study of transplant immunosuppressants vulnerable to claim denials under Medicare Part D coverage demonstrates a substantial gap between clinical practice, current FDA approval processes, and policy mandates for pharmaceutical coverage. This coverage barrier reduces access to life-saving medications for patients without alternative resources and may increase the risk of graft loss and death from medication nonadherence.
Original language | English (US) |
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Pages (from-to) | 1502-1509 |
Number of pages | 8 |
Journal | American Journal of Transplantation |
Volume | 18 |
Issue number | 6 |
DOIs | |
State | Published - Jun 2018 |
Keywords
- ethics and public policy
- immunosuppressant
- immunosuppression/immune modulation
- insurance
- insurance – public
- law/legislation
- off-label drug use
ASJC Scopus subject areas
- Immunology and Allergy
- Transplantation
- Pharmacology (medical)