Hawaii bill aims to make home dialysis easier

The bill is being promoted by a multinational company from Illinois that wants to sell products in Hawaii at a lower price.

A legislative proposal to change a little-known provision of Hawaii’s health care regulations could make it cheaper and easier to import products used for home dialysis treatment.

Baxter International, a multibillion-dollar Illinois-based medical device company that sells blood-cleaning solutions for peritoneal dialysis, approached Senator Maile Shimabukuro to introduce the bill. She cosponsored the measure, Senate Bill 473, along with Senators Stanley Chang and Lorraine Inouye.

Shimabukuro said he thought the bill was a good idea because he knows that many of his constituents in West Oahu have difficulty driving or getting transportation to and from dialysis clinics. She thinks increasing access to home dialysis would help them avoid commuting.

Her own relatives are dependent on dialysis, and she says it constantly interferes with their lives.

“We will be at a family party and they have to leave early because they have to go on dialysis,” he said.

Sen. Maile Shimabukuro, right, at a 2017 budget hearing, hopes the bill will help her constituents with diabetes on West Oahu.

Peritoneal dialysis is one of two types of dialysis for patients whose kidneys cannot filter the blood properly. Hemodialysis, which can be done at home or in a clinic, involves removing blood from the body and filtering it, and is usually done three times a week.

Peritoneal dialysis is mostly done at home and involves injecting a solution that filters the blood and then removing that solution. Peritoneal dialysis patients can filter their blood every day, sometimes while they sleep so they can work during the day.

Baxter makes blood-cleaning solutions for peritoneal dialysis, and current Hawaii law requires a licensed pharmacist to oversee the distribution of the product on the islands once it ships from the mainland.

“We are asking to amend Hawaii’s pharmacy practice law to eliminate the additional step of having a second pharmacist oversee the distribution of home dialysis solutions that are under our control from manufacturing in FDA-regulated facilities to delivery. in the patient’s home. said Jill Carey-Hargrave, a spokeswoman for Baxter. “The bill also reflects the current practices of manufacturers of home dialysis products in 34 other states.”

Kekoa McClellan, the Hawaii lobbyist for Baxter, said California has had a similar exemption on the books for 26 years. The idea behind SB 473 is to make importing peritoneal dialysis solution faster and cheaper.

“We have to have a licensed pharmacist sitting in the warehouse to look at and review this prescription after a licensed pharmacist has already looked at and shipped them,” he said. “(The bill) would mean we wouldn’t have to have a pharmacist sitting there or on call to come in and basically review a packing slip.”

The measure would also free up Hawaii pharmacists to help patients elsewhere, McClellan said, helping alleviate a shortage of healthcare providers in the state.

“It reduces the need for organizations like Baxter to have a full-time or on-call pharmacist where he or she could be serving our community elsewhere and actually filling prescriptions where they are needed,” he said.

Hawaii’s legislative session has just begun and the bill has yet to come up for a hearing, so there has been no opportunity for any opposition to raise their concerns. The Hawaii Pharmacy Association did not respond to an email seeking comment.

Glen Hayashida, executive director of the National Kidney Foundation of Hawaii, said he believes the criteria listed in the bill will ensure that product quality is maintained while expediting the delivery process for supplies that they are so needed.

Kalani Pagan receives dialysis during a 5-week training on how to use the machines with registered nurse Linda Tsui RN looking on.  The process takes a little less than 3 hours.
The dialysis process takes a little less than 3 hours and most patients go to clinics.

“It’s a good thing overall, but I didn’t know it was a monumental problem for patients at home,” he said.

The measure has been referred to the Senate Committee on Health and Human Services, led by Senator Joy San Buenaventura, and the Senate Committee on Commerce and Consumer Protection, led by Jarrett Keohokalole. He has not yet been scheduled for a hearing.

Hayashida said that if the bill goes forward, he will consult with home dialysis patients to see if it would be helpful.

In Hawaii, the dialysis industry has been booming, with companies like US Renal Care doubling their physical dialysis clinics in Hawaii over the past decade to care for patients with end-stage renal disease, particularly in rural communities. Native Hawaiians and other Pacific Islanders have disproportionately high rates of diabetes, which is a leading cause of kidney failure.

Demand for home dialysis is also growing locally and nationally, with companies promoting the option more frequently in the wake of the 2019 change in Medicare reimbursement rates for home dialysis. Not all patients are eligible for peritoneal dialysis, but some who choose that route say it’s less taxing than hemodialysis because it’s done more frequently and better reflects how the kidneys work.

Fresenius Kidney Care, doing business as Liberty Dialysis, said last year that 17% of its patients in Hawaii were dialyzing at home, noting that the rate has grown more than 18% in the last three years. The company expects 25% of its patients nationwide to be on home dialysis by 2025.

Nationally, between 2010 and 2020, the percentage of new dialysis patients using machines at home increased from 6.8% to 13.3%.

In Hawaii, peritoneal dialysis is most popular in Kauai County, where it is used by 14% of dialysis patients, and least popular in Oahu and Maui counties, where it is used by about 10% of dialysis patients . Nationally, rates range from 4.2% in parts of New York City to 46.5% in Ketchikan, Alaska, according to the US Kidney Data System.

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