[Congressional Record Volume 147, Number 66 (Tuesday, May 15, 2001)]
[Senate]
[Pages S4942-S4943]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DeWINE (for himself and Mrs. Lincoln):
  S. 880. A bill to amend title XVIII of the Social Security Act to 
provide adequate coverage for immunosuppressive drugs furnished to 
beneficiaries under the Medicare Program that have received an organ 
transplant, and for other purposes; to the Committee on Finance.
  Mr. DeWINE. Mr. President, I rise today to introduce a bill with my 
colleague, Senator Lincoln, to help those with End Stage Renal Disease, 
ESRD, who receive Medicare-eligible kidney transplants. Our bill would 
help these patients maintain access to life-saving drugs needed to 
prevent their immune systems from rejecting their new organs.
  With each kidney that is successfully transplanted, a gift of new 
life is given to the recipient. This precious gift should not be 
jeopardized simply because the recipient is unable to pay for the 
immunosuppressive drugs that help ensure that his or her immune system 
does not reject the new organ. It defies common sense for Medicare to 
cover expensive kidney transplant operations, but not cover the drugs 
necessary to preserve the transplanted organ.
  I would like to thank my colleagues for supporting the passage of 
most of the bill that I introduced last Congress--S. 631--which was 
passed as part of the Medicare Benefits and Improvement Protection Act, 
BIPA. This law eliminated the 36-month time limitation for Medicare 
coverage of immunosuppressive medications for transplant recipients who 
(1) received a Medicare transplant and (2) have Medicare-age or 
disability status. However, transplant recipients whose Medicare 
eligibility is based solely on their End Stage Renal Disease, ESRD, 
status did not qualify for the extended coverage under BIPA and remain 
limited to coverage for 36 months post-transplant.
  The bill we are introducing today simply would eliminate the 36-month 
time limitation for Medicare immunosuppressive drug coverage for the 
population that was not covered under last year's BIPA provision. Under 
current law, an individual with ESRD retains his or her Medicare 
coverage for all medical needs for 36 months post-transplant. This bill 
would eliminate the 36-month time limitation for the purpose of paying 
for the immunosuppressive drugs only--all other Medicare coverage, 
including that related to other post-transplant needs, would cease 
after 36 months, as under current law.
  A 1999 Institute of Medicine, IOM, study estimated the cost of 
providing indefinite coverage of all Medicare-covered kidney 
transplants at $848 million over five years. The IOM estimate of 
eliminating the time limitation for Medicare-aged and disabled 
transplant recipients only, covered under BIPA, was $566 million over 
five years. This represents a difference of only $282 million over five 
years to cover the rest of the ESRD population.
  Furthermore, our bill would make Medicare the secondary payer after 
36 months for beneficiaries who do not have Medicare-age or disability 
status, which the IOM report did not consider. Recipients covered by 
our bill would be subject to the same Part B premium, deductible, and 
coinsurance that other beneficiaries pay to receive full Part B 
coverage.

[[Page S4943]]

  Medicare will pay for another transplant (average cost is $100,000) 
or dialysis, annual cost is more than $50,000, if a transplant fails. 
It makes far better sense from an economic and social perspective to 
extend Medicare coverage for the anti-rejection medications especially 
at a time when the number of people waiting for a kidney transplant in 
this country exceeds 48,000 people.
  I urge my colleagues to support our bill and help those who receive 
Medicare-eligible transplants gain access to the immunosuppressive 
drugs they need to prevent their bodies from rejecting transplanted 
kidneys.
  This legislation is supported by the National Kidney Foundation, the 
American Society of Transplantation, the American Society of Pediatric 
Nephrology, the North American Transplant Coordinators Organization, 
LifeCenter, the Association of Organ Procurement Organizations, the 
American Kidney Fund, and the Polycystic Kidney Disease Foundation.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 880

       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 ``Immunosuppressive Drug 
     Coverage Act of 2001''.

     SEC. 2. PROVISION OF APPROPRIATE COVERAGE OF 
                   IMMUNOSUPPRESSIVE DRUGS UNDER THE MEDICARE 
                   PROGRAM.

       (a) Continued Entitlement to Immunosuppressive Drugs for 
     Kidney Transplant Recipients.--
       (1) In general.--Section 226A(b)(2) of the Social Security 
     Act (42 U.S.C. 426-1(b)(2)) is amended by inserting ``(except 
     for coverage of immunosuppressive drugs under section 
     1861(s)(2)(J))'' after ``shall end''.
       (2) Application.--In the case of an individual whose 
     eligibility for benefits under title XVIII of the Social 
     Security Act (42 U.S.C. 1395 et seq.) has ended except for 
     the coverage of immunosuppressive drugs by reason of the 
     amendment made by paragraph (1), the following rules shall 
     apply:
       (A) The individual shall be deemed to be enrolled in part B 
     of the original medicare fee-for-service program under title 
     XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) 
     for purposes of receiving coverage of such drugs.
       (B) The individual shall be responsible for the full part B 
     premium under section 1839 of such Act (42 U.S.C. 1395r) in 
     order to receive such coverage.
       (C) The provision of such drugs shall be subject to the 
     application of--
       (i) the part B deductible under section 1833(b) of such Act 
     (42 U.S.C. 1395l(b)); and
       (ii) the coinsurance amount applicable for such drugs (as 
     determined under such part B).
       (D) If the individual is an inpatient of a hospital or 
     other entity, the individual is entitled to receive coverage 
     of such drugs under such part B.
       (3) Establishment of procedures in order to implement 
     coverage.--The Secretary of Health and Human Services shall 
     establish procedures for--
       (A) identifying beneficiaries that are entitled to coverage 
     of immunosuppressive drugs by reason of the amendment made by 
     paragraph (1); and
       (B) distinguishing such beneficiaries from beneficiaries 
     that are enrolled under part B of title XVIII of the Social 
     Security Act for the complete package of benefits under such 
     part.
       (4) Technical amendment.--Subsection (c) of section 226A 
     (42 U.S.C. 426-1), as added by section 201(a)(3)(D)(ii) of 
     the Social Security Independence and Program Improvements Act 
     of 1994 (Public Law 103-296; 108 Stat. 1497), is redesignated 
     as subsection (d).
       (b) Extension of Secondary Payer Requirements for ESRD 
     Beneficiaries.--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 new sentence: ``With regard to 
     immunosuppressive drugs furnished on or after the date of 
     enactment of the Immunosuppressive Drugs Coverage Act of 
     2001, this subparagraph shall be applied without regard to 
     any time limitation.''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to drugs furnished on or after the date of 
     enactment of this Act.

     SEC. 3. PLANS REQUIRED TO MAINTAIN COVERAGE OF 
                   IMMUNOSUPPRESSIVE DRUGS.

       (a) Application to Certain Health Insurance Coverage.--
       (1) In General.--Subpart 2 of part A of title XXVII of the 
     Public Health Service Act (42 U.S.C. 300gg-4 et seq.) is 
     amended by adding at the end the following:

     ``SEC. 2707. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.

       ``A group health plan (and a health insurance issuer 
     offering health insurance coverage in connection with a group 
     health plan) shall provide coverage of immunosuppressive 
     drugs that is at least as comprehensive as the coverage 
     provided by such plan or issuer on the day before the date of 
     enactment of the Immunosuppressive Drug Coverage Act of 2001, 
     and such requirement shall be deemed to be incorporated into 
     this section.''.
       (2) Conforming amendment.--Section 2721(b)(2)(A) of the 
     Public Health Service Act (42 U.S.C. 300gg-21(b)(2)(A)) is 
     amended by inserting ``(other than section 2707)'' after 
     ``requirements of such subparts''.
       (b) Application to Group Health Plans and Group Health 
     Insurance Coverage Under the Employee Retirement Income 
     Security Act of 1974.--
       (1) In general.--Subpart B of part 7 of subtitle B of title 
     I of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1185 et seq.) is amended by adding at the end the 
     following new section:

     ``SEC. 714. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.

       ``A group health plan (and a health insurance issuer 
     offering health insurance coverage in connection with a group 
     health plan) shall provide coverage of immunosuppressive 
     drugs that is at least as comprehensive as the coverage 
     provided by such plan or issuer on the day before the date of 
     enactment of the Immunosuppressive Drug Coverage Act of 2001, 
     and such requirement shall be deemed to be incorporated into 
     this section.''.
       (2) Conforming amendments.--
       (A) Section 732(a) of the Employee Retirement Income 
     Security Act of 1974 (29 U.S.C. 1185(a)) is amended by 
     striking ``section 711'' and inserting ``sections 711 and 
     714''.
       (B) The table of contents in section 1 of the Employee 
     Retirement Income Security Act of 1974 is amended by 
     inserting after the item relating to section 713 the 
     following new item:

``Sec. 714. Coverage of Immunosuppressive drugs.''.

       (c) Application to Group Health Plans Under the Internal 
     Revenue Code of 1986.--Subchapter B of chapter 100 of the 
     Internal Revenue Code of 1986 is amended--
       (1) in the table of sections, by inserting after the item 
     relating to section 9812 the following new item:

``Sec. 9813. Coverage of immunosuppressive drugs.'';

     and
       (2) by inserting after section 9812 the following:

     ``SEC. 9813. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.

       ``A group health plan shall provide coverage of 
     immunosuppressive drugs that is at least as comprehensive as 
     the coverage provided by such plan on the day before the date 
     of enactment of the Immunosuppressive Drug Coverage Act of 
     2001, and such requirement shall be deemed to be incorporated 
     into this section.''.
       (d) Effective Date.--The amendments made by this section 
     shall apply to plan years beginning on or after January 1, 
     2002.
                                 ______