[Congressional Record Volume 153, Number 172 (Wednesday, November 7, 2007)]
[Senate]
[Pages S14066-S14067]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN (for himself and Mr. Cochran):
  S. 2320. A bill to amend title XVIII of the Social Security Act to 
provide continued entitlement to coverage for immunosuppressive drugs 
furnished to beneficiaries under the Medicare Program that have 
received a kidney transplant and whose entitlement to coverage would 
otherwise expire, and for other purposes; to the Committee on Finance.
  Mr. DURBIN. Mr. President, Organ transplantation is one of the most 
remarkable success stories in the history of medicine. No longer is it 
considered experimental. Today, transplants are accepted as the best 
treatment for certain diseases, including End Stage Renal Disease. 
Approximately 28,000 organ transplants were performed last year in the 
U.S. The vast majority of transplants are provided to patients in need 
of a kidney.
  Our Medicare system provides health care to millions of aged and 
disabled Americans, as well as those living with ESRD, each year. 
Thousands of Americans receive a Medicare-covered kidney transplant 
each year through the Medicare ESRD Program, which also covers 
dialysis, immunosuppressive drugs, and other medically important 
services.
  Unfortunately, there are long waiting lists for people who need an 
organ. Today there are over 98,000 individuals waiting for a 
transplant. For those lucky enough to receive one, the next challenge 
is to obtain coverage for immunosuppressive drugs--medications that 
organ transplant recipients must take every day for the life of their 
transplant to reduce the risk of organ rejection.
  In 2000, Congress wisely eliminated the 36-month time limitation for 
Medicare-aged and Medicare-disabled beneficiaries who had Medicare 
status at the time of transplant. Today, for an older or disabled 
person on Medicare, coverage for immunosuppressive drugs is covered for 
the life of the transplant.
  However, we still have an unfair and unrealistic gap in coverage for 
people with ESRD who are neither disabled nor elderly. For those 
transplant recipients, coverage for immunosuppressive drugs ends 36 
months after transplantation. For example, Medicare would pay for a 26-
year-old woman

[[Page S14067]]

living with ESRD to have lifelong dialysis at $50,000 per year. 
Medicare would cover the cost of a transplant for her at $100,000 per 
transplant operation. But, the immunosuppressive drugs she would need 
to ensure the organ is not rejected by her body are only covered by 
Medicare for 36 months, even though the drugs cost the Government only 
$15,000 per year.
  This is economically inefficient and morally wrong. Without regular 
access to immunosuppressive drugs to prevent rejection, many patients 
find themselves back in a risky and frightening place--in need of a new 
kidney. This senseless cycle of care costs taxpayers a lot of money and 
puts thousands of lives on the line.
  I am pleased to introduce today, along with my colleague from 
Mississippi, Senator Thad Cochran, the Comprehensive Immunosuppressive 
Drug Coverage for Transplant Patients Act. This legislation would 
alleviate the disparity between coverage for immuno-suppresive drugs 
among Medicare beneficiaries. It is time to provide lifetime coverage 
for immunosuppressive drugs through Medicare. We will reduce the need 
for dialysis and kidney re-transplants and provide reliable, sustained 
access to critically important, life-saving medications for thousands 
of Americans. In the long run, we will save money and lives.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
placed in the Record, as follows:

                                S. 2320

       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 Kidney Transplant 
     Patients Act of 2007''.

     SEC. 2. PROVISION OF APPROPRIATE COVERAGE OF 
                   IMMUNOSUPPRESSIVE DRUGS UNDER THE MEDICARE 
                   PROGRAM FOR KIDNEY TRANSPLANT RECIPIENTS.

       (a) Continued Entitlement to Immunosuppressive Drugs.--
       (1) Kidney transplant recipients.--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.--Section 1836 of the Social Security Act 
     (42 U.S.C. 1395o) is amended--
       (A) by striking ``Every individual who'' and inserting 
     ``(a) In General.--Every individual who''; and
       (B) by adding at the end the following new subsection:
       ``(b) Special Rules Applicable to Individuals Only Eligible 
     for Coverage of Immunosuppressive Drugs.--
       ``(1) In general.--In the case of an individual whose 
     eligibility for benefits under this title has ended except 
     for the coverage of immunosuppressive drugs by reason of 
     section 226A(b)(2), the following rules shall apply:
       ``(A) The individual shall be deemed to be enrolled under 
     this part for purposes of receiving coverage of such drugs.
       ``(B) The individual shall be responsible for the full 
     amount of the premium under section 1839 in order to receive 
     such coverage.
       ``(C) The provision of such drugs shall be subject to the 
     application of--
       ``(i) the deductible under section 1833(b); and
       ``(ii) the coinsurance amount applicable for such drugs (as 
     determined under this part).
       ``(D) If the individual is an inpatient of a hospital or 
     other entity, the individual is entitled to receive coverage 
     of such drugs under this part.
       ``(2) Establishment of procedures in order to implement 
     coverage.--The Secretary shall establish procedures for--
       ``(A) identifying beneficiaries that are entitled to 
     coverage of immunosuppressive drugs by reason of section 
     226A(b)(2); and
       ``(B) distinguishing such beneficiaries from beneficiaries 
     that are enrolled under this part for the complete package of 
     benefits under this part.''.
       (3) Technical amendment.--Subsection (c) of section 226A of 
     the Social Security Act (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 Comprehensive Immunosuppressive Drug 
     Coverage for Kidney Transplant Patients Act of 2007, 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 FOR KIDNEY TRANSPLANT 
                   RECIPIENTS.

       (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 FOR KIDNEY 
                   TRANSPLANT RECIPIENTS.

       ``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 in connection with a kidney transplant 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 
     Comprehensive Immunosuppressive Drug Coverage for Kidney 
     Transplant Patients Act of 2007, 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 FOR KIDNEY 
                   TRANSPLANT RECIPIENTS.

       ``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 in connection with a kidney transplant 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 
     Comprehensive Immunosuppressive Drug Coverage for Kidney 
     Transplant Patients Act of 2007, 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. 1191(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 for kidney transplant 
              recipients.'';

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

     ``SEC. 9813. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS FOR KIDNEY 
                   TRANSPLANT RECIPIENTS.

       ``A group health plan shall provide coverage of 
     immunosuppressive drugs in connection with a kidney 
     transplant that is at least as comprehensive as the coverage 
     provided by such plan on the day before the date of enactment 
     of the Comprehensive Immunosuppressive Drug Coverage for 
     Kidney Transplant Patients Act of 2007, 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, 
     2008.
                                 ______