Opinion | Congress must act to protect dialysis patients

As the senior pastor of Dexter Avenue Baptist Church, I care for both the spiritual and physical health of my congregation. With a predominantly Black congregation, fighting proposed policies that would worsen the already unconscionable health inequities, increase barriers to quality care, and deliver adverse outcomes experienced by America’s Black community is one of my top priorities. At the top of that list is addressing policies impacting treatments for patients with chronic kidney disease (CKD) because of its devastating toll on Black Americans.

According to the Centers for Disease Control and Prevention, 20% of the non-Hispanic Black population has CKD versus 12% of non-Hispanic white adults. Poorly managed CKD often progresses to kidney failure, requiring individuals to undergo dialysis a few times weekly to stay alive. While Blacks make up about 13% of the population, they account for 35% of the people with kidney failure, or end stage renal disease (ESRD) and 33% of those on dialysis in the United States.

Dialysis is a life-changing medical treatment, often consuming 10-12 hours per week at the dialysis clinic. I know personally, because my mother, who passed away in March of 2017, suffered from kidney disease. I know the challenge that she had going to dialysis weekly and how it was a life-altering experience for her and our entire family. Clearly, it is important to do everything possible to help CKD patients manage the enormous burden and challenges associated with dialysis.

Most individuals with CKD on dialysis depend upon the Medicare program to provide dialysis services and needed medications. Due to the significant impact of CKD on the Black community, I’m concerned about an upcoming policy change advanced by the Centers for Medicare and Medicaid Services (CMS) that will severely limit access to certain medications, known as orally administered phosphate lowering therapies (PLTs), for dialysis patients. We must do all we can to help those who are suffering!

Dialysis patients take orally administered PLTs to prevent hyperphosphatemia and currently receive these essential medications at their community pharmacy through Medicare Part D. Many phosphate-lowering therapies are available; patients often need two different medications to control their phosphorus level adequately, and the appropriate medication or mix of medications varies from patient to patient.  

Unless Congress intervenes, CMS will implement a policy in January prohibiting PLTs from being paid for and provided under Medicare Part D, resulting in access to these essential medications at community pharmacies being denied. CMS plans to move phosphate-lowering therapies into the “ESRD bundle” — a set and often inadequate amount paid to the dialysis center to cover the cost of all services and therapies administered during dialysis.

This action by CMS would further exacerbate health inequities experienced by Black dialysis patients. Because dialysis centers are underfunded, they typically operate using one-size-fits-all protocols and will presumably not offer a wide range of phosphate lowering therapies.

Properly controlling hyperphosphatemia requires frequent monitoring of phosphorus levels and the availability of the most clinically appropriate phosphate-lowering therapies (PLTs). These two critical components of hyperphosphatemia management will not exist for dialysis patients if CMS moves orally administered phosphate-lowering therapies (PLTs) into the ESRD bundle. As a result, CKD patients may experience treatment complications, worse health outcomes, and reduced quality of life. With approximately 80% of dialysis patients dependent on PLTs, this CMS policy will significantly impact the ESRD community.

Dialysis patients need these essential medications to remain available through Medicare Part D at their community pharmacy. Shifting orally administered phosphorus-lowering therapies into the ESRD bundle will reduce access and jeopardize the health and lives of dialysis patients — one-third of whom are Black.  

Congress must act NOW in passing the Kidney PATIENT Act of 2023 to protect dialysis patients from this CMS policy.