Maryland Health Secretary Nelson J. Sabatini said yesterday that his department will resume paying for a new immunosuppressant drug used by kidney transplant patients in a state-funded program.
But Sabatini said restoration of coverage for the drug known as Rapamune will not affect a decision to halt reimbursement for about 80 other pharmaceuticals that were dropped from the Maryland Kidney Disease Program in mid-April.
His action on Rapamune followed a barrage of protests by patients, advocates and kidney specialists who said the ban on the drug was putting patients at risk because there is no known substitute.
"What we've decided is ... if there's any question, then put it back on," Sabatini said yesterday in an interview.
Patient advocates said they were pleased with Sabatini's decision on Rapamune, but said coverage also needs to be restored for a dozen other drugs.
The state cut off reimbursement for the 80 drugs because their manufacturers refused to participate in a rebate program required under a 1999 state law.
Under the program, the state gets a rebate equal to about 16 percent of the cost of the individual drugs.
Created in 1972, the state Kidney Disease Program serves about 2,350 patients who are not fully covered by Medicare or private health plans.
Barbara A. Bradford, director of the program, said 535 people in the program are transplant patients, with the balance on dialysis.
Health officials say about 75 of the transplant patients had been taking Rapamune, the trademark name for sirolimus, manufactured by Wyeth Pharmaceuticals of Collegeville, Pa. State officials said a month's supply of Rapamune costs about $527.
Sabatini said that Wyeth is considering joining the rebate program, with a decision expected next week. Company officials did not respond to a request for comment.
"I'm optimistic that they're going to join," Sabatini said.
The health secretary said the ban on reimbursement for the other drugs will remain because he is satisfied that other medications are available.
"The experts we consulted said there were clinical alternatives," Sabatini said, adding that he had contacted a kidney specialist who reviewed the list.
His contention, however, was disputed by Lauren Young of the Maryland Disability Law Center. She said experts consulted by her organization, including Dr. Edward S. Kraus, a Johns Hopkins Hospital kidney specialist, found several other drugs on the banned list for which there are no therapeutic equivalents.
"We have requested reinstatement of 12 drugs based on information from five different doctors," Young said, adding that she believed the state acted without considering "the critical needs of patients."
"These patients have a legal right under state statute to drugs which their doctors determine are legally necessary," Young added.
She urged transplant patients who have been denied necessary drugs under the program to contact the state attorney general's office.
