Adam\u00a0<\/b>S.\u00a0<\/b>Wilk<\/b><\/strong><\/p>\n<\/div>\n \u201cBecause so much about the business practices of Medicare Advantage plans are considered proprietary information, we do not have much systematically collected information on how its prior authorization requirements and networks interface with patients\u2019 transplant care pathways,\u201d Wilk told Healio. \u201dAnecdotal information from some transplant centers, nephrologists, social workers and patients indicates these tools of managed care may play a few different roles.\u201d<\/p>\n
The researchers assessed early transplant outcomes among 56,775 patients (mean age, 60.4 years; 43.8% women; 53.5% Black) on dialysis from the United States Renal Data System from 2015 to 2021. They evaluated associations between insurance type and transplant referrals within 1 year of starting dialysis, transplant evaluation within 6 months of referral and wait-listing within 1 year of evaluation start through the Early Steps to Transplant Access Registry for the Southeast. <\/p>\n
Results showed 22,007 adults received a transplant referral and 11,256 started the evaluation process.<\/p>\n
Patients with Medicare Advantage plans had significantly lower odds of receiving a transplant referral (subdistribution HR = 0.93; 95% CI, 0.89-0.97) vs. those with traditional Medicare. No significant differences were observed between Medicare Advantage and traditional Medicare regarding transplant evaluation starts or wait-listing when adjusting for patient and community-level differences, according to the researchers.<\/p>\n
Additionally, subgroup analysis revealed patients younger than 65 years with Medicare Advantage had lower referral odds vs. those with traditional Medicare, according to the researchers.<\/p>\n
The findings suggest patients with Medicare Advantage plans may be less likely to receive a transplant referral, according to the researchers.<\/p>\n
Based on anecdotal information, Wilk said, prior authorization requirements and Medicare Advantage plans\u2019 hospital and physician networks may be a factor in the lower transplant referral rates. <\/p>\n
\u201cThese paperwork efforts are generally considered burdensome by patients and care teams, and Medicare Advantage plans have some track record of denying prior authorization requests even when they shouldn\u2019t, as observed in some reports from the Office of Inspector General of HHS,\u201d Wilk said. \u201cThen, if hospital or physician networks make it more challenging to find a transplant center or specialist in network, patients will be less likely to complete the transplant evaluation.\u201d<\/p>\n
Wilk said some challenges posed by Medicare Advantage plans may be partly \u201coffset\u201d by some of its benefits.<\/p>\n
\u201cMedicare Advantage\u2019s out-of-pocket maximums, reduced out-of-pocket spending for services like prescription drugs and other benefits like dental care could lead to some better transplant outcomes,\u201d Wilk said. \u201cThese plans may also focus more narrowly on \u2018higher-quality\u2019 hospitals and physicians, though their definition of \u2018quality\u2019 is not transparent to us.\u201d<\/p>\n
Overall, clinicians should be able to inform patients interested in transplant about the potential benefits and barriers based on their insurance plan, Wilk said.<\/p>\n
Furthermore, Wilk said future research on Medicare Advantage plans may need federal policy involvement to receive more transparent plan information and assess patient outcomes.<\/p>\n
\u201cIf research can show that Medicare Advantage plan networks of transplant hospitals are deterring patients from pursuing transplant at all, then it may be appropriate for federal regulators to institute network adequacy requirements to ensure enrollees have adequate access to transplant hospitals,\u201d he said. \u201cIt may also be necessary for policymakers to mandate that Medicare Advantage plans disclose network information or prior authorization requirements publicly and institute auditing procedures to ensure that information disclosed is accurate.\u201d<\/p>\n
For more information:<\/h2>\n Adam <\/b>S. <\/b>Wilk, PhD,<\/b> can be reached at aswilk@iu.edu or on LinkedIn.<\/p>\n\n
\n
Published by:<\/span>\n
Sources\/Disclosures<\/h3>\n Source: <\/h2>\n Wilk AS, et al. Abstract G-625. Presented at: NKF Spring Clinical Meetings; May 6-10, 2026; New Orleans.<\/p>\n
\n
Disclosures: <\/strong>
<\/p>\n
\n
\n
<\/p>\n
Ask a clinical question<\/strong> and tap into Healio AI’s knowledge<\/strong> base.<\/p>\n
<\/p>\nPubMed, enrolling\/recruiting trials, guidelines<\/li>\n
<\/p>\n
Clinical Guidance, Healio CME, FDA news<\/li>\n
<\/p>\n
Healio’s exclusive daily news coverage of clinical data<\/li>\n
\n <\/ul>\n
Learn more<\/button>\n <\/div>\n<\/div>\n
![\"nephrology](\"https:\/\/www.healio.com\/~\/media\/h5\/feature\/news\/publogos\/neph.svg?la=en&h=30&w=142&hash=48DB28B29782E956859750F4CE62F92F\")
\n <\/div>\n<\/p><\/div>\n<\/p><\/div>\n