[Congressional Record Volume 159, Number 23 (Wednesday, February 13, 2013)]
[Senate]
[Pages S714-S715]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN (for himself and Mr. Cochran):
  S. 323. A bill to amend title XVIII of the Social Security Act to 
provide for extended months of Medicare coverage of immunosuppressive 
drugs for kidney transplant patients and other renal dialysis 
provisions; to the Committee on Finance.
  Mr. DURBIN. Mr. President, today I am introducing the Comprehensive 
Immunosuppressive Drug Coverage for Kidney Transplant Patients Act with 
my colleague Senator Thad Cochran.
  More than 26 million American adults are living with chronic kidney 
disease. Fortunately, many of these individuals are able to improve 
their condition through medication and lifestyle change.
  But more than half of a million Americans live with irreversible 
kidney failure or end-stage renal disease. They have only two choices 
to survive--both of them hard. They can receive regular and frequent 
dialysis or they can receive a kidney transplant.
  In 1972, Congress made a commitment to individuals with end-stage 
renal disease, or ERSD, to cover the treatment they needed, including 
possible transplants, under Medicare, regardless of their age.
  Organ transplantation is a medical success story. Thousands of kidney 
transplants are done every year, and for the patients fortunate enough 
to receive a donated organ, the quality and length of their lives can 
be dramatically improved.
  But not everyone who needs a donated kidney receives one. There are 
currently more than 100,000 Americans on the waiting list for a kidney 
transplant.
  Last year, 15,000 transplants were performed while more than 30,000 
people were added to that waitlist.
  Derek Haney is one of the lucky ones who beat those odds and received 
a kidney transplant.
  Derek is a brave young man raised in Effingham, IL, a small city in 
central Illinois.
  In 2008 the unexpected happened. Derek became chronically ill. After 
regular trips to the hospital, Derek's doctors discovered that his 
kidneys were only functioning at 10 percent. At the age of 23, Derek 
was diagnosed with end stage renal disease.
  For the next two and a half years of his life, Derek underwent 
dialysis. Three times a week he would go in a 4-hour dialysis 
treatment, while he waited for a kidney. The dialysis treatments meant 
that Derek had to put his college plans on hold, but he continued to 
work full-time and never gave up hope.
  On July 15, 2010, Derek got his new kidney.
  Two and a half years later, Derek is still healthy. He is pursuing a 
degree in business administration at a local community college. He 
hopes to transfer soon to a university where he can work toward a CPA 
license.
  Fortunate1y for Derek and his family, Medicare covered the expense of 
dialysis--more than $75,000 a year for 2\1/2\ years. Medicare also paid 
for Derek's kidney transplant at a cost of about $110,000.
  For the last two and a half years, Medicare has covered the expensive 
immunosuppressive medication Derek must take for the rest of his life 
to ensure that his body doesn't reject his new kidney.
  Here's the problem: Derek's Medicare coverage runs out in July.
  Without Medicare coverage, Derek will be burdened with prescription 
drug costs of roughly $1500 per month--more than he and almost any 
family could afford.
  There is an unfair and unrealistic gap in coverage for people with 
end stage renal disease who, like Derek, are neither elderly nor 
disabled.
  For those transplant recipients, Medicare coverage, including 
coverage of immunosuppressive drugs, ends 36 months after 
transplantation.
  If only the need to continue the immunosuppressive drugs also ended 
36 months after transplantation. But it doesn't.
  Without immunosuppressive drugs to prevent rejection, many patients 
find themselves back in a risky and frightening place--in need of a new 
kidney.
  A recent New England Journal of Medicine report estimates that 
extending immunosuppressive drug coverage to people who now lose it 
after 36 months will save Medicare approximately $200 million a year by 
helping to prevent kidney rejections.
  Extending immunosuppressive drug coverage saves lives and it saves 
money.
  Sadly, Derek isn't alone. It is estimated that over 45,000 successful 
transplant recipients are at risk of losing their immunosuppressive 
drug coverage.
  This makes no sense morally, medically or economically.
  I am pleased to join my Republican colleague, Senator Cochran, in 
introducing the Comprehensive Immunosuppressive Drug Coverage for 
Kidney Transplant Patients Act.
  This bipartisan 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.
  Our legislation will reduce the need for dialysis and repeated kidney 
transplants. It will provide reliable, sustained access to critically 
important, life-saving medications for thousands of Americans.
  In both moral and economic terms, this is the right decision and I 
urge our colleagues to join us in passing this reasonable, targeted, 
lifesaving bill.
  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:

[[Page S715]]

                                 S. 323

       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 2013''.

     SEC. 2. EXTENDED MONTHS OF COVERAGE OF IMMUNOSUPPRESSIVE 
                   DRUGS FOR KIDNEY TRANSPLANT PATIENTS AND OTHER 
                   RENAL DIALYSIS PROVISIONS.

       (a) Medicare Entitlement to Immunosuppressive Drugs for 
     Kidney Transplant Recipients.--
       (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 eligibility for enrollment under part 
     B solely for purposes of coverage of immunosuppressive drugs 
     described in section 1861(s)(2)(J))'' before ``, with the 
     thirty-sixth month''.
       (2) Individuals eligible only for coverage of 
     immunosuppressive drugs.--
       (A) Section 1836 of the Social Security Act (42 U.S.C. 
     1395o) is amended--
       (i) by striking ``Every'' and inserting ``(a) In General.--
     Every''; and
       (ii) by inserting at the end the following new subsection:
       ``(b) Individuals Eligible for Immunosuppressive Drug 
     Coverage.--Beginning on January 1, 2014, every individual 
     whose insurance benefits under part A have ended (whether 
     before, on, or after such date) by reason of section 
     226A(b)(2) is eligible for enrollment in the insurance 
     program established by this part solely for purposes of 
     coverage of immunosuppressive drugs.''.
       (B) Conforming amendment.--Sections 1837, 1838, and 1839 of 
     the Social Security Act (42 U.S.C. 1395(p), 42 U.S.C. 
     1395(q), 42 U.S.C. 1395(r)) are each amended by striking 
     ``1836'' and inserting ``1836(a)'' each place it appears.
       (3) Enrollment for individuals only eligible for coverage 
     of immunosuppressive drugs.--Section 1837 of the Social 
     Security Act (42 U.S.C. 1395(p)) is amended by adding at the 
     end the following new subsection:
       ``(m)(1) Any individual who is eligible under section 
     1836(b) to enroll in the medical insurance program 
     established under this part for purposes of coverage of 
     immunosuppressive drugs may enroll only in such manner and 
     form as may be prescribed by regulations, and only during an 
     enrollment period described in this subsection.
       ``(2) An individual described in paragraph (1) may enroll 
     beginning on the first day of the third month before the 
     month in which the individual first satisfies section 
     1836(b).
       ``(3) An individual described in paragraph (1) whose 
     entitlement for hospital insurance benefits under part A ends 
     by reason of section 226A(b)(2) on or after January 1, 2014, 
     shall be deemed to have enrolled in the medical insurance 
     program established by this part for purposes of coverage of 
     immunosuppressive drugs.''.
       (4) Coverage period for individuals only eligible for 
     coverage of immunosuppressive drugs.--
       (A) In general.--Section 1838 of the Social Security Act 
     (42 U.S.C. 1395q) is amended by adding at the end the 
     following new subsection:
       ``(g) In the case of an individual described in section 
     1836(b), the following rules shall apply:
       ``(1) In the case of such an individual who is deemed to 
     have enrolled in part B for coverage of immunosuppressive 
     drugs under section 1837(m)(3), such individual's coverage 
     period shall begin on the first day of the month in which the 
     individual first satisfies section 1836(b).
       ``(2) In the case of such an individual who enrolls in part 
     B for coverage of immunosuppressive drugs under section 
     1837(m)(2), such individual's coverage period shall begin on 
     the first day of the month in which the individual first 
     satisfies section 1836(b) or the month following the month in 
     which the individual so enrolls, whichever is later.
       ``(3) The provisions of subsections (b) and (d) shall apply 
     with respect to an individual described in paragraph (1) or 
     (2).
       ``(4) In addition to the reasons for termination under 
     subsection (b), the coverage period of an individual 
     described in paragraph (1) or (2) shall end when the 
     individual becomes entitled to benefits under this title 
     under section 226(a), 226(b), or 226A.''.
       (B) Conforming amendments.--Section 1838(b) of the Social 
     Security Act (42 U.S.C. 1395q(b)) is amended, in the matter 
     following paragraph (2), by adding ``or section 1837(m)(3)'' 
     after ``section 1837(f)'' each place it appears.
       (5) Premiums for individuals only eligible for coverage of 
     immunosuppressive drugs.--Section 1839 of the Social Security 
     Act (42 U.S.C. 1395r) is amended--
       (A) in subsection (b), by adding at the end the following 
     new sentence: ``No increase in the premium shall be effected 
     for individuals who are enrolled pursuant to section 1836(b) 
     for coverage only of immunosuppressive drugs.''; and
       (B) by adding at the end the following new subsection:
       ``(j) Determination of Premium for Individuals Only 
     Eligible for Coverage of Immunosuppressive Drugs.--The 
     Secretary shall, during September of each year, determine and 
     promulgate a monthly premium rate for the succeeding calendar 
     year for individuals who enroll only for the purpose of 
     coverage of immunosuppressive drugs under section 1836(b). 
     Such premium shall be equal to 35 percent of the monthly 
     actuarial rate for enrollees age 65 and over, determined 
     according to paragraph (1), for that succeeding calendar 
     year. The monthly premium of each individual enrolled for 
     coverage of immunosuppressive drugs under section 1836(b) for 
     each month shall be the amount promulgated in this 
     subsection. Such amount shall be adjusted in accordance with 
     subsections (c) and (f).''.
       (6) Government contribution.--Section 1844(a) of the Social 
     Security Act (42 U.S.C. 1395w(a)) is amended--
       (A) in paragraph (3), by striking the period at the end and 
     inserting ``; plus'';
       (B) by adding at the end the following new paragraph:
       ``(4) a Government contribution equal to the estimated 
     aggregate reduction in premiums payable under part B that 
     results from establishing the premium at 35 percent of the 
     actuarial rate under section 1839(j) instead of 50 percent of 
     the actuarial rate for individuals who enroll only for the 
     purpose of coverage of immunosuppressive drugs under section 
     1836(b).''; and
       (C) by adding at the end the following flush matter:
     ``The Government contribution under paragraph (4) shall be 
     treated as premiums payable and deposited for purposes of 
     subparagraphs (A) and (B) of paragraph (1).''.
       (7) Extension of secondary payer requirements for esrd 
     beneficiaries eligible for coverage of immunosuppressive 
     drugs.--Section 1862(b)(1)(C) of the Social Security Act (42 
     U.S.C. 1395(y)(b)(1)) is amended by adding at the end the 
     following new sentence: ``With regard to immunosuppressive 
     drugs furnished to an individual who enrolls for the purpose 
     of coverage of immunosuppressive drugs under section 1836(b) 
     on or after January 1, 2014, this subparagraph shall apply 
     without regard to any time limitation, except that when such 
     individual becomes entitled to benefits under this title 
     under sections 226(a) or 226(b), or entitled to or eligible 
     for benefits under this title under section 226A, the 
     provisions of subparagraphs (A) and (B), and the time 
     limitations under this subparagraph, respectively, shall 
     apply.''.
       (8) Ensuring coverage under the medicare savings program.--
     Section 1905(p)(1)(A) of the Social Security Act (42 U.S.C. 
     1396d(p)(1)(A)) is amended by inserting ``or an individual 
     who is enrolled under part B for the purpose of coverage of 
     immunosuppressive drugs under section 1836(b)'' after 
     ``section 1818''.
       (9) Part d.--Section 1860D-1(a)(3)(A) of the Social 
     Security Act (42 U.S.C. 1395w-101(a)(3)(A)) is amended by 
     inserting ``(but not including an individual enrolled solely 
     for coverage of immunosuppressive drugs under section 
     1836(b))'' before the period at the end.
                                 ______