Health Alert

PHILADELPHIA (CBS 3) ― On the Health Alert a policy that's wasting your money and putting lives in danger.  Medical Reporter Stephanie Stahl uncovers the policy that everyone says doesn't make sense.

43-year-old Leonard Porter of Philadelphia is spending extra time with his children, fearing his days are numbered.

"It's hard, cry every day.  So that's what I'm going through now.  Making a way to pay for my funeral," said Leonard.  His kidneys were destroyed by chronic high blood pressure, but he got a transplant in 2003.  His brother donated one of his kidneys.

Leonard, like all transplant patients, has to stay on anti-rejection drugs forever.  And that's where this story goes haywire, and involves everyone who pays taxes.

"I'm so angry with our system," said Leonard.

For those patients who qualify, Medicare pays for kidney transplants.  It also pays for the cost of the drugs, covered at 80 percent.  But if someone has Medicare only because of kidney failure, their coverage ends after 36 months.  It was then Leonard said his pharmacy told him he no longer qualified.  He says there was no way he could pay $30,000 a year for the drugs.   

"And I'm like wow, how am I going to pay for this medicine?" asked Leonard.  So his transplanted kidney failed and he's now on dialysis.  With a port in his chest, Leonard is hooked up to a machine three times a week to keep him alive.  The dialysis, paid for by Medicare, costs more than double the price of the drugs.

"They're willing to pay for my dialysis which is $71,000 a year, but not willing to pay for the medicine which is half that price.  I don't understand that.  I'm very angry," said Leonard.

"It's always frustrating," said Dr. John Daller, the head of Temple's Transplant program where Leonard received his new kidney.  He says this specific policy that stops paying for anti-rejection drugs doesn't make sense.  Patients can be thrown into impossible situations.

"They're forced to make choices of, do I work?  Do I put food on my families table?  Do I pay for rent or do I worry about getting my medications this month," said Dr. Daller.

We asked Philadelphia Congresswoman Allyson Schwartz, who's on the committee that overseas Medicare, about the policy. 

Stephanie Stahl said to Schwartz, "This is a provision that is wasting taxpayer money, and also potentially putting lives at risk."

Schwartz replied, "I can't justify it.  You know, sometimes these rules are made and then over time we learn that they were not the right rules to make."

A revision is pending in Congress to extend the anti-rejection drug coverage.  Nobody knows when or if it will pass.  The sad irony is that Medicare says Leonard was still covered because he became eligible for Medicare due to disability, after the transplant.  When we started asking questions, Medicare said Leonard was "unaware of what he was entitled to..." and it did not know why he was told he no longer qualified.

For Leonard, who now needs another transplant, he has a new mission.

"Making sure my children are all right if I don't make it through tomorrow," said Leonard.

It's not clear who fouled up in this case.  Medicare says it is looking into the situation with the pharmacy.  The pharmacy chain told us today it will look into the matter.

Temple says it has a team to support transplant patients, but can't comment because of privacy issues.

Regardless, thousands of people will continue to be affected by what many consider to be a confusing and unfair law.  And there's the cost on top of that.  The cost of dialysis is far more than the drugs, and if someone needs another transplant, the government pays for that operation too.

RELATED LINK:
Find Help With the Cost of Medicine- http://www.needymeds.org/

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