Recent changes to Medicare law were designed to provide better drug coverage and hold down prices, but some health advocates are worried the shift may hurt one group of patients -- those with organ transplants.

		GRAPHIC Disappearing drugs

The new law, approved by Congress in November, expands coverage to all prescription drugs by 2006 but cuts reimbursement payments to pharmacies for immunosuppressants, the expensive medicine transplant patients take to keep their bodies from rejecting new organs.

"We are very concerned looking forward that drug stores won't stock these drugs," said Dolph Chianchiano, vice president of health policy and research at the National Kidney Foundation. "We are beginning to hear patient complaints."

Complaints are also coming from pharmacists. For example, the reimbursement cuts prompted Echo Transplant Pharmacy in Flushing, N.Y. to stop taking new Medicare patients late last month.

About half the pharmacy's 1,000 patients are on Medicare, and owner Boris Mantell said he will ask those clients to find a new drug store if the government doesn't change its policies in 45 days.

Mantell said he can only buy two of the four biggest-selling immunosuppressants at prices below the government reimbursement rate.

"I'm losing money on these drugs the minute they come in the door," Mantell said.

The drugs cost Medicare at least $10,000 a year for each patient, Chianchiano said. The Medicare rate reductions -- by 10 percentage points -- "could mean a store taking a $1,000 or $2,000 hit," said John Rector, general counsel of the National Community Pharmacists Association.

"I would think our members will stop carrying these drugs. They won't want to, but they may have to," he said.

Paul T. Kelly, vice president of federal legislative affairs at the National Association of Chain Drug Stores, said his members may continue to carry the drugs as a community service, or because they can profit on other items patients purchase. But he added the reduction "might cause a pharmacy to say this just isn't worth it."

The Kidney Foundation has asked the Centers for Medicare and Medicaid Services to grant immunosuppressive drugs an exception to the changes. It has not received an answer.

However, the agency has exempted CellCept, the country's best-selling immunosuppressant, at the request of manufacturer Roche. A government spokeswoman couldn't say what CellCept's reimbursement rate would be.

Wyeth is considering seeking an exemption for its immunosuppressant, Rapamune.

The United Network for Organ Sharing estimates there are 176,870 patients taking immunosuppressive drugs. Exactly how many get their drugs through Medicare is unclear, but in 2000 there were 74,725 people with kidney transplants covered by Medicare, according to the United States Renal Data System.