While there is much that is still unknown about COVID-19, the disease caused by the novel coronavirus, one reality that has become explicitly clear over the past 4 months is the pandemic’s disproportionate effect on minority populations, as well as those suffering from underlying health conditions such as chronic kidney disease (CKD).
Unfortunately, these two variables often go hand-in-hand. Long before the present pandemic, the burdens imposed by kidney disease fell heavily on America’s minority groups, and particularly African Americans, who suffer from kidney failure at far higher rates than their Caucasian counterparts. Now, with federal data showing that Black Medicare patients are nearly four times as likely to be hospitalized as a result of COVID-19, the thin veil over America’s appalling health disparities has been irrevocably lifted.
The roots of these disparities can be traced back a century, and even the most ardent racial justice advocates recognize that we cannot fix decades of structural healthcare inequality in the context of a fast-moving public health crisis. We can, however, ask our policymakers to take urgent and necessary policy steps to safeguard vulnerable patient populations and mitigate the severest effects of COVID-19 on these underserved groups, including within the kidney care community.
For starters, policymakers should prioritize the removal of onerous prior authorization requirements that stifle CKD patient access to critical treatment and care. A requirement that physicians obtain approval from an insurer before prescribing what is often medically necessary treatment, prior authorization imposes superfluous process layers on physicians and patients at a time when our healthcare system is already stretched to the limit.
Worse still, treatments for chronic diseases that fall heavily on minority populations, such as CKD, are often the most frequent subject of these prior authorization regulations. In the context of COVID-19, where immuno-compromised CKD patients already face access shortages as they self-isolate at home, continuing to impose prior authorization requirements that only delay the delivery of treatment are counterproductive and impose disproportionate burdens on our most vulnerable patient populations.
The Centers for Medicare & Medicaid Services has already taken unprecedented steps to expand patient treatment access through a slew of recently announced policy updates. By requesting that health insurance companies move to immediately waive “prior authorization” requirements for the duration of the current national emergency, the agency can continue building off the enormous progress it has made in other areas.
As kidney patients continue to abide by CDC recommendations to self-isolate at home, another challenge that arises are the dangers associated with traveling to medical facilities to receive dialysis, IV-iron infusions to treat iron anemia, and other medically necessary treatments associated with CKD that are commonly delivered in the outpatient setting.
Reporting from The New York Times and The Washington Post has highlighted the threat of potential viral transmission that vulnerable kidney patients face at dialysis and other in-person treatment centers — a problem that will continue long after the number of confirmed coronavirus cases reaches its zenith.
Expecting already at-risk populations to congregate together in these facilities, whether dialysis or infusion centers, must be accompanied by revamped social distancing and infection control policy, as well as policy measures that ensure more patients can treat their disease in the home setting where possible.
While the stakeholders in the kidney care community have already made great strides towards increasing access to CKD treatments that can be delivered at home, such as home dialysis, more help is needed from federal policymakers to ensure vulnerable patients, particularly those covered by Medicare, can access these treatments.
On this front in particular, providing coverage under Medicare Part D for FDA-approved oral treatments for conditions associated with kidney disease would be a great way to keep vulnerable patients at home without risking exposure through visits to infusion centers or other hospital outpatient facilities.
Fortunately, lawmakers on both sides of the aisle have recognized this problem and introduced a potential legislative remedy. The Renal Anemia Innovation Support and Expansion (RAISE) Act (H.R. 8177), which was recently introduced by Reps. Larry Bucshon (R-Ind.), Tom O’Halleran (D-Ariz.), Markwayne Mullin (R-Okla.), and G.K. Butterfield (D-N.C.), would implement a minor regulatory update that would allow CKD patients to administer effective oral treatments for renal anemia in the home setting.
This simple fix, which has the backing of the nation’s leading kidney patient and physician advocacy organizations, would ensure that thousands of vulnerable patients are able to treat their renal anemia safely at home while abiding by CDC guidelines and avoiding crowded infusion centers.
Passage of the RAISE Act, wedded with other regulatory changes to support patient access to medically necessary care, would be small but significant steps forward towards strengthening America’s kidney treatment infrastructure. Now, as underserved populations who disproportionately suffer from chronic diseases such as CKD cope with the newly imposed challenges brought on by COVID-19, the federal government must take every conceivable step to streamline access to necessary and life-saving care.
Julianne Malveaux, PhD, is an economist, author, and president of economic education and president emerita of Bennett College in Greensboro, North Carolina.