[Congressional Record Volume 146, Number 45 (Tuesday, April 11, 2000)]
[Senate]
[Pages S2541-S2542]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN (for himself and Mr. Levin):
  S. 2399. A bill to amend title XVIII of the Social Security Act to 
revise the coverage of immunosuppressive drugs under the Medicare 
program; to the Committee on Finance.


 comprehensive immunosuppressive drug coverage for transplant patients 
                              act of 2000

 Mr. DURBIN. Mr. President, I rise to make a few remarks 
concerning this bill I am introducing today, which will help many 
Medicare beneficiaries who have had organ transplants.
  Every year, over 4,000 people die waiting for an organ transplant. 
Currently, over 62,000 Americans are waiting for a donor organ. It is 
this scarcity that has fueled the current controversy over organ 
allocation.
  Given that organs are extremely scarce, Federal law should not 
compromise the success of organ transplantation. Yet that is exactly 
what current Medicare policy does, because Medicare denies certain 
transplant patients coverage for the drugs needed to prevent rejection.
  Medicare does this in three different ways. Firstly, Medicare has 
time limits on coverage of immunosuppressive drugs. Permanent Medicare 
law only provides immunosuppressive drug coverage for 3 years with 
expanded coverage totaling 3 years and 8 months between 2000 and 2004. 
However, 61 percent of patients receiving a kidney transplant after 
someone has died still have the graft intact 5 years after 
transplantation. 76.6 percent of patients receiving a kidney from a 
live donor still have their transplant intact after 5 years post 
transplantation. For livers, the graft survival rate after 5 years is 
62 percent. For hearts, the 5 year graft survival rate is 67.7 percent. 
So many Medicare beneficiaries lose coverage of the essential drugs 
that are needed to maintain their transplant.
  Secondly, Medicare does not pay for anti-rejection drugs for Medicare 
beneficiaries, who received their transplants prior to becoming a 
Medicare beneficiary. So for instance, if a person received a 
transplant at age 64 through their health insurance plan, when they 
retire and rely on Medicare for their health care they will no longer 
have immunosuppressive drug coverage.
  Thirdly, Medicare only pays for anti-rejection drugs for transplants 
performed in a Medicare approved transplant facility. However, many 
beneficiaries are completely unaware of this fact and how it can 
jeopardize their future coverage of immunosuppressive drugs. To receive 
an organ transplant, a person must be very ill and many are far too ill 
at the time of transplantation to be researching the intricate nuances 
of Medicare coverage policy.
  The bill that I am introducing today, the ``Comprehensive 
Immunosuppressive Drug Coverage for Transplant Patients of 2000 Act'' 
would remove these short-sighted limitations. The bill sets up a new, 
easy to follow policy: All Medicare beneficiaries who have had a 
transplant and need immunosuppressive drugs to prevent rejection of 
their transplant, would be covered as long as such anti-rejection drugs 
were needed.
  I am introducing this bill on behalf of some of the constituents that 
I have met who are unfortunately very adversely affected by the current 
gaps in Medicare coverage.
  Richard Hevrdejs was a Chicago attorney in private practice until 
1993. Unfortunately, he suffered a debilitating heart attack that year, 
which left him unable to work and on disability. In 1997, suffering 
from congestive heart failure, he was placed on a Heart-Mate machine at 
the University of Illinois Medical Center (UIC). In April of 1998, he 
received a heart transplant at UIC but because UIC was not at the time 
a Medicare approved facility for heart transplants, Medicare will not 
cover his immunosuppressive drugs. Richard was near death when he had 
his transplant and was in no condition to research the intricacies of 
Medicare coverage policies. His drug costs are now around $25,000 per 
year. He gets some assistance from the drug company medical assistance 
plans and he has a Medigap policy that provides a little assistance. 
But for the most part, he is forced to watch all his savings dwindle 
because of Medicare's coverage gaps.
  Anita Milton is from Morris, Illinois. In 1995, she became so 
disabled that she was no longer able to work and was forced onto 
disability. The following year, her lungs gave up and  she had to have 
a bilateral lung transplant. Because Medicare s not available for 2 
years after a person becomes eligible for disability, Anita was not on 
Medicare when she had the transplant. Today, the huge bills for the 
transplant remain at collection agencies. Because Anita was not on 
Medicare when she received her transplant, she does not receive 
Medicare coverage for the antirejection drugs that she needs. She 
receives $940 in disability payments per month. She is now on Medicaid 
but due to the spend down requirements in Illinois, she must spend $689 
on drug costs to get Medicaid converge for her drugs. In effect, she 
gets coverage every month. Anita cannot afford her anti-rejection drugs 
and she tried to scale back on them. This caused her to nearly reject 
the transplant. Consequently, she has lost a third of her lung capacity 
permanently. As Anita said at a Town Hall meeting in Chicago in January 
``these Medicare and Medicaid rules make no sense.''

  I am introducing this bill on the same day that another bill the 
``Organ Transplant Act of 2000'', which I am an original cosponsor is 
also being introduced. The ``Organ Transplant Fairness Act'' also seeks 
to change another aspect of Federal law to improve the Nation's organ 
allocation system. The two bills are good companions. It makes little 
sense to improve the organ allocation system to maximize the success of 
organ transplantation and increase the number of lives saved, if we do 
not at the same time reduce the ways that Medicare jeopardizes 
transplants by denying transplant patients the anti-rejection drugs 
they need to maintain their transplant.
  Mr. President, I ask unanimous consent that a copy of the bill the 
``Comprehensive Immunosuppresive Drug Coverage for Transplant Patients 
of 2000'' be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2399

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Comprehensive 
     Immunosuppressive Drug Coverage for Transplant Patients Act 
     of 2000''.

     SEC. 2. REVISION OF COVERAGE OF IMMUNOSUPPRESSIVE DRUGS UNDER 
                   THE MEDICARE PROGRAM.

       (a) Revision.--
       (1) In general.--Section 1861(s)(2)(J) of the Social 
     Security Act (42 U.S.C. 1395x(s)(2)(J))

[[Page S2542]]

     (as amended by section 227(a) of the Medicare, Medicaid, and 
     SCHIP Balanced Budget Refinement Act of 1999 (113 Stat. 
     1501A-354), as enacted into law by section 1000(a)(6) of 
     Public Law 106-113) is amended by striking ``, to an 
     individual who receives'' and all that follows before the 
     semicolon at the end and inserting ``to an individual who has 
     received an organ transplant''.
       (2) Conforming amendments.--
       (A) Section 1832 of the Social Security Act (42 U.S.C. 
     1395k) (as amended by section 227(b) of the Medicare, 
     Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 
     (113 Stat. 1501A-354), as enacted into law by section 
     1000(a)(6) of Public Law 106-113) is amended--
       (i) by striking subsection (b); and
       (ii) by redesignating subsection (c) as subsection (b).
       (B) Subsections (c) and (d) of section 227 of the Medicare, 
     Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 
     (113 Stat. 1501A-355), as enacted into law by section 
     1000(a)(6) of Public Law 106-113, are repealed.
       (3) Effective date.--The amendments made by this subsection 
     shall apply to drugs furnished on or after the date of 
     enactment of this Act.
       (b) Extension of Certain Secondary Payer Requirements.--
     Section 1862(b)(1)(C) of the Social Security Act (42 U.S.C. 
     1395y(b)(1)(C)) is amended by adding at the end the 
     following: ``With regard to immunosuppressive drugs furnished 
     on or after the date of enactment of the Comprehensive 
     Immunosuppressive Drug Coverage for Transplant Patients Act 
     of 2000, this subparagraph shall be applied without regard to 
     any time limitation.''.
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