Bill Introduced in Congress to Cover Pancreas Transplants

On May 18, Congressional Diabetes Caucus co-chair George Nethercutt, R-Wash., and colleagues Reps. Lois Capps D-Ca., John Edward Porter R-Ill. and John LaFalce D-N.Y., introduced H.R. 4495. The bill, known as the Insulin-Free World Medicare Pancreas Transplantation Coverage Act, would provide Medicare coverage for all “medically necessary” pancreas transplants.

In a “Dear colleague” letter, sent out by the bill’s sponsors to House members, Nethercutt and colleagues urged other legislators to support the bill.

No Kidney Failure, No Transplant!

Nethercutt points out that on July 1, 1999, Medicare began providing coverage for pancreas transplants under limited circumstances. Coverage is now provided for transplants performed in people who have had and who also require kidney transplants. However, coverage is denied for transplants in people who have not yet reached kidney failure.

Deb Butterfield, executive director of the Insulin-Free World (IFW) Foundation, the organization for which H.R. 4495 was named, says she has been advocating for Medicare coverage of pancreas transplants for years.

“We’ve been working to get the rules changed so that Medicare will also cover pancreas transplants alone for Medicare beneficiaries, and that puts pressure on commercial insurance companies to follow suit,” says Butterfield.

Several studies, including one published in The New England Journal of Medicine in July 1998, indicate that a pancreas transplant performed before kidney disease can eliminate the need for a kidney transplant in the future.

“Studies have shown that getting a pancreas transplant before kidneys regress too far can obviate the need for a kidney altogether,” says Butterfield. “With the waiting list getting longer and longer for kidneys, it is increasingly difficult for people with diabetes without living donors to get kidneys through the national list before they are on dialysis. And survival for people on dialysis is less than 50 percent for two years.”

Success Rate is 83 Percent

Nethercutt and Butterfield say the success rate for pancreas-only transplants is 83 percent. This is the same or higher than heart transplants at 83 percent, liver transplants at 77 percent and lung transplants at 71 percent. The success of pancreas-only transplants is slightly less than that of kidney transplants at 88 percent.

“While a pancreas transplant is not the preferred course of treatment for most individuals with diabetes, it is for many the best option to living a healthy and productive life,” says Nethercutt. “For some, it is the only option.”

Butterfield encourages people to write their members of Congress to get H.R. 4495 passed.

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