A picture of Senator Richard J. Durbin
Richard D.
Democrat IL

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  • Statements on Introduced Bills and Joint Resolutions

    by Senator Richard J. Durbin

    Posted on 2013-02-13

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    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.

    ______ By Mr. CORNYN (for himself, Mr. McConnell, Mr. Roberts, Mr. Hatch, Mr. Cochran, Mr. Grassley, Mr. Shelby, Mr. McCain, Mr. Inhofe, Mr. Sessions, Ms. Collins, Mr. Enzi, Mr. Crapo, Ms. Murkowski, Mr. Chambliss, Mr. Graham, Mr. Alexander, Mr. Burr, Mr. Coburn, Mr. Thune, Mr. Isakson, Mr. Vitter, Mr. Corker, Mr. Barrasso, Mr. Wicker, Mr. Johanns, Mr. Risch, Mr. Kirk, Mr. Coats, Mr. Blunt, Mr. Moran, Mr. Portman, Mr. Boozman, Mr. Toomey, Mr. Hoeven, Mr. Rubio, Mr. Johnson of Wisconsin, Mr. Paul, Mr. Lee, Ms. Ayotte, Mr. Heller, Mr. Scott, Mr. Flake, Mr. Cruz, and Mrs. Fischer): S.J. Res. 7. A joint resolution proposing an amendment to the Constitution of the United States relative to balancing the budget; to the Committee on the Judiciary.

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