Challenges of Heart Transplant

1. Challenges of Heart Transplant Stephanie Martinez Transplant Financial Coordinator Team Lead 7777 Forest Lane, Bldg. C-770 Dallas, TX 75230

2. Heart Failure: • Ischemic Cardiomyopathy • Non-Ischemic Cardiomyopathy • Viral • Drug Induced • Hypertension • Hypothyroidism • Valves

3. Financial Resources • Insurance Plans • Medicare • Medicaid • Managed Care (PPO, HMO,POS,EPO) • State Risk Pool • Individual Policy • Cobra

4. Assess Financial: • Income (SSI, SSDI, Wages) • Household debt • Funding • Savings • Fundraising • Budget • Household bills • Pay credit card debits • Financial support: i.e. family, friends, church

5. Medicare part B: Pays 80% of Immunos 20% to secondary coverage Medicare part D: Prior Authorization often needed Tiered formulary Dilemma: Can’t afford to pay $350/month if there is no secondary coverage If patient does not qualify for low income subsidy, then there may be a gap/doughnut hole Medication Coverage New Trend: Private insurance have moved toward percentages instead of set co-pays

6. Stressors often identified • Limited Income • Resources • Medication Coverage • Post-clinic transportation • Limited family support

7. Challenges: • On disability, unemployed due to severity of illness • Waiting period of 2 years to get Medicare • Underinsured

8. Ventricular Assist Devices (VADs) • Bridge to transplant • Destination Therapy • Recovery

9. Challenges: • Experimental/Investigational • Underinsured • Policy Restrictions • Dressing

10. FDA approved as a bridge to transplant Pump weighs12 ounces (less then 1 pound) 4 cm diameter & 6 cm long Heartmate II

11. FDA approved as a bridge to transplant & destination therapy Pump Weighs 2 ½ pounds 2 inches thick & 4 inches around Heartmate XVE

12. Summary • The financial aspect of transplant is not problem free. Direct and indirect financial stressors can effect patient outcomes.