My brother has low albumin level and has been given a dialysis solution that has protein in it. The problem is according to what the dialysis center has been told the company is giving my brother the solution as a charity case and this will only be good for 3 months. I am trying to find out if I change his prescription drug coverage that will cover this treatment. I am concerned that if he does not get approved on this continued charity program we will not be able to get this treatment going further which will effect his health.
There can be many medical reasons why someone has a low albumin level other than malnutrition, including infection, inflammation, and liver or heart problems. Have other causes of his low albumin been ruled out?
What kind of dialysis does your brother do? The peritoneal dialysis treatment removes more protein than hemodialysis. Does your brother have some kind of GI problem that limits his body’s absorption of nutrients from eating or does he not have much of an appetite? There are drugs that stimulate appetite. Here’s an article about the use of one such drug in people with kidney disease and on dialysis. https://www.mdedge.com/clinicianreviews/article/97389/nephrology/megestrol-acetate-ckd-and-dialysis-patients
Medicare Part B covers “parenteral” and “enteral nutrition” for eligible Medicare patients under certain conditions. You might want to share this CMS info with your brother’s doctor to see if he qualifies for Part B coverage. This is discussed in Section 180.2.
If Part B isn’t an option, the NCOA Center for Benefits Access fact sheet describes what standard Part D plans can and cannot cover. Products for weight gain are excluded by law in standard Medicare Part D plans. However, some “enhanced” Part D plans may cover some nutritional supplements. NCOA fact sheet also has links for pharmaceutical assistance programs.
You can use the Medicare drug plan finder at https://www.medicare.gov/find-a-plan/questions/home.aspx to see if any plans cover what he’s getting. To do this, you’ll need to know the name of the product. You might want to ask the dietitian or doctor what other products might work as well.
Does your brother have Medicaid or VA benefits? Those may cover nutritional supplements. Your brother’s dietitian should be able to help you research options.
Hello Beth, Thank you sooo much for your reply. You have given me a lot of items to research and that is great. I will take a look at what you had said and see if these can help us. My brother is doing peritoneal dialysis. He started it in June 2018 and it has not been easy. Many medical situations have occurred. He was on hemo dialysis before this and never had this much problem with his protein levels. I do not think there is anything else impeding his absorption of protein. He does not have much of an appetite like he use to… I think that is due in part to the peritoneal dialysis and dwelling during the day.
I will review and forward all the resources you sent to me.
How is his PD adequacy (Kt/V)? It should be 1.7 or better. If he’s not draining well, he may not be getting good dialysis (adequacy <1.7) and he could be absorbing sugar from the dialysate remaining in his body.
Dialysis clinics are supposed to do a peritoneal equilibration test (PET) on each patient every 4 months to see how well the lining of the peritoneal cavity is transporting wastes. Some people do better on CAPD than CCPD based on whether their transport rate is slow (best on CAPD), fast (best on CCPD/cycler) or average (can do either). You might ask the clinic about the results of this test. You can read about the PET here. https://www.homedialysis.org/life-at-home/articles/the-peritoneal-equilibration-test-for-pd
Dialysis solutions are not billed thru a Part D plan. Please work with your center insurance specialist for coverage. Dialysis solutions are billed by the Center and do not go thru Part D plans.
Dialysis solutions (called dialysate) for hemodialysis and peritoneal dialysis are not considered “nutritional supplements”. When a patient has Medicare as his/her primary payer, the dialysis clinic bills Medicare Part B for his/her dialysis solutions, any dialysis-related equipment and supplies, and staff time for “support services” (clinic and home visits) for home patients under a single charge each day the patient does dialysis. Dialysis clinics may bill commercial payers differently based on contracts with those payers.