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GAO-24-107230 1 (2024-08-08)

handle is hein.gao/gaoqqk0001 and id is 1 raw text is: Why This Matters Key Takeaways Over 27,000 kidney transplants were performed in the United States in 2023. A kidney transplant is the preferred method of treatment for patients with end-stage renal disease (ESRD)-a condition of permanent kidney failure requiring regular dialysis or a kidney transplant to maintain life. Compared to dialysis, a functional transplanted kidney may offer patients a better quality of life and increase their chances of living longer. Kidney transplant patients must take daily immunosuppressive drugs for the life of their transplant to prevent kidney rejection. Kidney rejection will result in kidney failure, requiring patients to go on dialysis or undergo another transplant. Most patients with ESRD, regardless of age, are eligible for Medicare. This Medicare ESRD coverage ends 36 months after patients receive a kidney transplant unless they are otherwise eligible for Medicare. The Consolidated Appropriations Act, 2021 (CAA) extended Medicare coverage of immunosuppressive drugs for certain kidney transplant patients whose Medicare ESRD coverage has ended. The CAA included a provision for us to report on the implementation of the Medicare immunosuppressive drug benefit, which took effect January 1, 2023. This report provides information on Medicare's immunosuppressive drug benefit, including enrollment and oversight activities taken by the Centers for Medicare & Medicaid Services (CMS). * Medicare's immunosuppressive drug benefit helps certain kidney transplant patients pay for their immunosuppressive drugs. Patients whose Medicare ESRD coverage has ended are eligible for the benefit if they are not enrolled in certain other types of health coverage. The benefit is limited to immunosuppressive drugs and does not cover other Medicare services. Patients are responsible for premiums and other cost sharing, and enroll via attestation of no other health coverage that would make them ineligible for the benefit. * There were 104 patients enrolled in the benefit as of February 2024. In addition, another 146 patients enrolled and then disenrolled in the benefit from January 2023 through February 2024 for various reasons, such as nonpayment of premiums. * CMS requires a verbal or written attestation from patients about their eligibility to enroll in the benefit. CMS also reviews enrollment data it receives from the Social Security Administration to check patient eligibility for the benefit. CMS's efforts at the time of our review are consistent with agency statements that CMS will monitor compliance with the benefit's eligibility requirements and address any concerns. Page 1 GAO-24-107230 Kidney Transplants Page 1 GAO-24-107230 Kidney Transplants

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