CONGRESS: Immunosuppressive Drug Coverage for Kidney Transplant Patients

[okarol]

Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2007 (Introduced in House)

HR 3282 IH

110th CONGRESS

1st Session

H. R. 3282

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.

IN THE HOUSE OF REPRESENTATIVES

August 1, 2007

Mr. CAMP of Michigan (for himself, Mr. KIND, Mr. BURGESS, Mr. WELLER of Illinois, Mr. CLAY, Mr. LATHAM, Mr. HINCHEY, Mr. COSTA, and Mr. BARROW) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce and Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

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.

      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. 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 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.


http://capwiz.com/kidney/webreturn/?url=http://thomas.loc.gov/cgi-bin/query/z?c110:H.R.3282:

[Chris]

Just glad I am not in politics. Reading that makes me need a code book in order to know what the heck they are referring to. They need to condense their writings and save some paper!

[pelagia]

Here's a translation courtesy of the PKD Foundation advocacy page:
 
"The Comprehensive Immunosuppressive Drug Coverage for Transplant Patients Act of 2007 (H.R. 3282) was introduced recently in the U.S. House. The bill extends Medicare coverage for anti-rejection medications beyond the current 36-month limit. Passing this bill in Congress is a top priority for the PKD Foundation.
 
Overview:
 
[I edited out a bit about PKD] While Medicare covers dialysis indefinitely, it will only cover vital immunosuppressive drugs for kidney transplants for 36 months, unless the transplant patient is also eligible for Medicare coverage because of age or disability (the individual is receiving Social Security Disability Insurance).
 
Once the 36-month period ends, transplant patients are forced to find other ways to pay for these expensive medications. (Those who are ESRD beneficiaries, but are not 65, are not eligible for the new Medicare Prescription Drug Benefit.) Many patients cannot afford immunosuppressive drugs without the help of Medicare, increasing the chances they will be forced back on dialysis or to undergo another transplant.
 
Medicare coverage of immunosuppressive drugs is far less costly ($15,000 per year) than resuming kidney dialysis (at least $50,000 per year) or the cost of a transplant ($100,000 per transplant).
 
This legislation ends the 36-month cap for anti-rejection medications. In addition to the PKD Foundation, this bill also has the support of the National Kidney Foundation, the American Society of Transplant Surgeons and the Association of Organ Procurement Organization, among other groups.
 
Congressional Action So Far:
 
The legislation was introduced on August 1, 2007, by Reps. Dave Camp (R-MI) and Ron Kind (D-WI). There are eight co-sponsors of the bill. The bill was referred to the Education and Labor Committee, the Ways and Means Committee and the Energy and Commerce Committee for consideration.
 
The Senate version of this bill (S. 2320) was introducted on November 7, 2007."

This is the sort of thing you can contact your Congressional Rep. about.  It takes about 5 minutes to make a phone call.  Or go to one of the major kidney orgs and they will almost certainly have info about how to write a letter.

[Chris]

There is a problem though with Medicare Part B and D though if you use their prescription service that is a hassle. For some reason you need special authorization from the doctor that has to be sent in to them beside the prescription to order your meds and it is not dealt with the same department when you order your other medications that go along with your transplant. So far this has been one big hassle to go from a monthly supply of meds from a mail order pharmacy to a 90 day supply of medications. Not to mention a big price increase compared to an added up total from a monthly supply. But the mail order pharmacy was giving me to much trouble and worries ever since CVS bought my old mail order pharmacy.

They need to work on theiir system of ordering prescriptions all together.

[Sunny]

Seems obvious to me that Congress needs to provide medications necessary for the lifetime of a transplanted organ. The alternative is the
possibility recipients do not take the medicines needed because they can't afford it and then end up with organ rejection. The whole concept seems so simple to
me that I really don't understand how we even got here in the first place. This is a no brainer. Let's hope Congress does whats right, not to mention what
seems logical, regarding this issue.

[okarol]

Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients
(H.R. 3282 and S. 2320)

This bill is 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. It amends SSA title II (Old Age, Survivors and Disability Insurance) (OASDI) to: (1) continue entitlement to prescription drugs used in immunosuppressive therapy furnished to an individual who receives a kidney transplant for which payment is made under Medicare; and (2) extend Medicare secondary payer requirements for end stage renal disease (ESRD) beneficiaries.

One-Page Informational Document

The bill H.R. 3282 was introduced by Rep Camp, Dave [MI-4] on 8/1/2007

Visit GovTrack to view the House Response http://www.govtrack.us/congress/bill.xpd?bill=h110-3282

The bill S. 2320 was introduced by Sen Durbin, Richard [IL] on 11/7/2007

Visit GovTrack to view the Senate Response http://www.govtrack.us/congress/bill.xpd?bill=s110-2320

[Zach]

This is another important bill that needs our support.
 

[pelagia]

Some questions I have and maybe someone knows the answers or has enough knowledge of the way Medicare works now to give me an idea.

Right now our insurance covers Stephen's meds and there is no limit (time or dollar) except for co-pays.  At some point (I think it's after 3 years, or maybe it's 30 months...), Medicare will pay for 3 years.  Then we will be going back to our insurance.  If this bill passes will his drug costs then be paid by Medicare, rather than shifting back to our insurance?  Or would it work the way the transplant costs themselves do.  For transplant, I think Medicare pays if you don't have primary insurance.  They are still working out the paperwork for Stephen's transplant, but from what I know so far, I believe our insurance is paying for the transplant surgery and the donor's surgery.

[okarol]

I believe Medicare will pay only for the period you qualify for meds (30 months after dialysis begins..? Shoot I cannot recall...) and they become primary. The coverage ends 36 months from the day of transplant, and your own insurance would again cover the anti-rejection meds. Many patients (like Jenna) who have never had a full time job or aren't married to someone with health insurance would have no coverage at the 36 month mark (eeek, 18 months to go for her!) so we are hoping she can still get Part B drug coverage if this bill goes forward.

[Rerun]

I agree that this bill needs to pass.  But, the point of a transplant is to make you healthy again and you can go out and get a JOB that has benefits.  Why should you be on the dole your whole life just because you have a transplant.  GET A JOB! 

     

[okarol]

If you get a job that has full insurance benefits then you can drop the Part B (the coverage is only for the meds) and that's the goal. Finding a job right now is a challenge, I am glad you got one  Rerun. Jenna is working 3 days a week, not much but she's still looking for something more. Unfortunately she's got no experience or college. And SSI is already withholding payments because she's working, so it's a challenge to get by. Most part time jobs don't offer insurance benefits, and now many corporations are finding ways to exclude preexisting conditions.

[pelagia]

I know that Medicare is important for many folks with ESRD. 

For our case though, from what I can tell so far, I much prefer the insurance plan that we have through my job to anything associated with Medicare.  I am thankful that I have tenure at a university so there is no way we are going to lose our health insurance unless they close the university.  But, from what I understand (and Karol mentioned), at 30 months from the date of transplant (or date dialysis began), the costs of a transplant recipient's prescription drugs are covered by Medicare (Part B?), which becomes the primary insurer for a period of 3 years, rather than by the private insurer.  This doesn't seem to be optional, but maybe I am missing something, because what would happen if we didn't sign up for part B?  We were told by our transplant clinic social worker that we need to have Part B as a "safety net" for Stephen's donor, in case he should have any complications down the road.  I guess even if part B is optional for Stephen, we still feel an obligation to purchase it for that reason.  But, I am still wondering how the primary/secondary insurance thing will end up working for us if the law changes.  Would we be forced to have Medicare as the primary forever because we enrolled for part B to cover the donor?