[Congressional Record Volume 155, Number 42 (Tuesday, March 10, 2009)]
[Senate]
[Pages S2973-S2974]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN (for himself, Mr. Cochran, Mr. Levin, and Mr. 
        Dorgan):
  S. 565. 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. March 12 is recognized as World Kidney Day, a day to 
raise awareness of the major health and societal costs of kidney 
disease. Today, 26 million American adults have chronic kidney disease, 
and 500,000 have irreversible kidney failure, or end-stage renal 
disease ESRD. These patients require dialysis or a kidney transplant to 
survive.
  Fortunately, medical advancements have transformed organ 
transplantation from an experimental procedure into the accepted and 
often best treatment for organ failure. Transplantation has prolonged 
and improved the lives of thousands of Americans. Over 16,000 Americans 
received a kidney transplant in 2007, and 150,000 today are living with 
functioning kidney transplants.
  Many of these kidney transplants were paid for by the Medicare 
system, which provides health care to aged and disabled Americans, as 
well as those living with ESRD. For these ESRD patients, Medicare also 
covers dialysis for patients who have not received a donor kidney and 
immunosuppressive drugs for kidney transplant recipients. Organ 
transplant recipients must take immunosuppressive drugs 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 
aged and disabled beneficiaries who had Medicare status at the time of 
transplant. So today, for an older or disabled person on Medicare, 
immunosuppressive drugs are covered by Medicare 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. 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.
  Since Medicare covers the cost of the transplant for end stage renal 
disease, it makes sense for Medicare to preserve

[[Page S2974]]

this investment by covering antirejection drugs. It would be far less 
expensive for Medicare to cover immunosuppressive drugs at a cost of 
$10,000 to $20,000 a year than to pay for dialysis--$71,000 a year--or 
another transplant, $106,000, if a patient's kidney fails and he is 
once again eligible for Medicare coverage.
  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 allow 
kidney transplant recipients to continue Medicare coverage for the 
purpose of immunosuppressive drugs only. All other Medicare coverage 
would end 36 months after the transplant.
  It is time to take this step to provide continuous coverage for 
immunosuppressive drugs through Medicare. This is a logical and moral 
move that will reduce the need for dialysis and kidney retransplants 
and provide reliable, sustained access to critically important, 
lifesaving medications for thousands of Americans. In the long run, we 
will save both 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 
printed in the Record, as follows:

                                 S. 565

       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 2009''.

     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 Eligible Only 
     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 2009, 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. 2708. 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 2009, 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 2708)'' 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. 715. 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 2009, 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. 1191a(a)) is amended by 
     striking ``section 711'' and inserting ``sections 711 and 
     715''.
       (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 714 the 
     following new item:

``Sec. 715. 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 9813 the following new item:

``Sec. 9814. Coverage of immunosuppressive drugs for kidney transplant 
              recipients.'';

     and
       (2) by inserting after section 9813 the following:

     ``SEC. 9814. 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 2009, 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, 
     2010.
                                 ______