Medicaid would cover at-home INR tests under proposed law

Move is “common sense,” says sponsor

By: - January 17, 2024 4:09 pm

Dr. Tessa London-Bounds (right) and Amanda Crabtree, a registered nurse (left) work together to advocate for better access to at-home INR testing. (Photo provided)

FRANKFORT — A Republican House bill would make life easier — and potentially safer — for Kentuckians taking blood thinners for their mechanical heart valves, according to a University of Kentucky physician and nurse.

Rep. Deanna Frazier Gordon, R-Richmond, introduced House Bill 31 on the first day of the 2024 legislative session. Her bill, which has bipartisan support, would require Medicaid coverage for at-home International Normalized Ratio (INR) kits, which cost less than in-person INR tests and produce results much faster. 

Rep. Deanna Frazier Gordon, R-Richmond. (LRC Public Information)

The estimated 3,000 Kentuckians who need this coverage are often survivors of substance use disorders, said Amanda Crabtree, a registered nurse who’s worked at UK for eight years and treats a lot of patients in recovery from IV drug use. 

“IV drug use with a dirty needle can cause fungal growth on the valves of the heart,” Crabtree explained. 

The culprit is usually a contaminated needle, she said, and can involve any drug used intravenously — including heroin, fentanyl, meth and cocaine. 

Either way, the result is the same: “a lot of them have to get valve replacements,” she said. 

There are two options for this surgery. Patients can get a valve replacement using tissue from a pig or cow, which won’t last and requires repeat, risky and expensive surgeries every seven to 15 years that can cost up to $86,000 a pop

Or, the patient can get a mechanical valve replacement, which will last for life. But, the patient must then be on blood thinners for the rest of their life. 

The mechanical valve is the “gold standard” for patients because they are long lasting and don’t require repeat surgeries, said Dr. Tessa London-Bounds, a cardiothoracic surgeon with UK. 

When taking blood thinners, patients have to get their blood tested on a weekly basis to make sure their blood is the “appropriate level of thin,” Crabtree explained. If the patient’s blood is too thin, they’re at risk of bleeding and need a decreased dose. If the blood is too thick, there is risk of blood clot and stroke, so the patient needs a higher dosage. 

There is a machine — which retails for around $800 to $1,200 — that can test blood at home with the prick of a finger and give the patient results right away. With this kit, Crabtree said, the patient can get their dose adjusted much faster. 

A mechanical valve can last for life and is needed to treat endocarditis (infected heart valves) brought on by IV drug use with a contaminated needle. (UK photo)

The catch? Medicaid doesn’t cover the at-home INR kits. That means Crabtree’s patients need to travel to Lexington to get their blood tested on a weekly basis, sometimes spending hours in the car each time to do this simple but required needle prick. 

At-home tests are cost effective, too, according to numbers provided to the Lantern by UK. In-person INR testing costs about $3,952 per year, and Medicaid covers it. That price tag drops to $1,100 for at-home testing. 

“The in-person lab draws end up being more expensive because they have to pay the lab personnel and all the inner workings of running an actual lab with people in it,” said Crabtree. 

And, these draws can be painful and traumatic for people in recovery from IV drug use, she explained. 

(UK photo)

“(For) the patients, especially, that have a history of substance use. It’s really hard to find a vein because their veins have been used so much,” Crabtree said. “So that’s another barrier where patients don’t want to come in and have their blood drawn, because it hurts and it takes a long time of somebody digging around in their arm trying to find a good vein to get a blood sample from.” 

Frazier Gordon, an audiologist, told the Lantern she believes part of the coverage inconsistency is because “a lot of times we just do stuff because that’s the way it’s always been and sometimes there’s not awareness of changes in technology” such as remote oversight over testing. 

At-home INR testing “does appear to provide better care for the patient,” she said. “And then, also, it’s a cost savings for the state.” 

In conversations with colleagues, she said, she’s received “lots of support” for the legislation and “I do feel like it will be something that will be addressed.” 

Fixing this inconsistency, said Frazier Gordon, is just “common sense.”

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Sarah Ladd
Sarah Ladd

Sarah Ladd is a Louisville-based journalist from West Kentucky who's covered everything from crime to higher education. She spent nearly two years on the metro breaking news desk at The Courier Journal. In 2020, she started reporting on the COVID-19 pandemic and has covered health ever since. As the Kentucky Lantern's health reporter, she focuses on mental health, LGBTQ+ issues, children's welfare, COVID-19 and more.

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