II

107TH CONGRESS

1ST SESSION S. 1204

To amend title XVIII of the Social Security Act to provide adequate coverage

for immunosuppressive drugs furnished to beneficiaries under the medicare program that have received an organ transplant.

IN THE SENATE OF THE UNITED STATES

JULY 19, 2001

Mr. DURBIN (for himself, Mr. ROCKEFELLER, Mr. EDWARDS, Mr. BIDEN, Mr.

DORGAN, Mr. JOHNSON, and Mr. LEVIN) introduced the following bill;

which was read twice and referred to the Committee on Finance

A BILL

To amend title XVIII of the Social Security Act to provide

adequate coverage for immunosuppressive drugs furnished to beneficiaries under the medicare program that

have received an organ transplant.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Comprehensive Im5 munosuppressive Drug Coverage for Transplant Patients

6 Act of 2001’’.
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1 SEC. 2. COMPREHENSIVE COVERAGE OF IMMUNO2 SUPPRESSIVE DRUGS UNDER THE MEDICARE

3 PROGRAM.

4 (a) IN GENERAL.—Section 1861(s)(2)(J) of the So5 cial Security Act (42 U.S.C. 1395x(s)(2)(J)), as amended

6 by section 113(a) of the Medicare, Medicaid, and SCHIP

7 Benefits Improvement and Protection Act of 2000 (114

8 Stat. 2763A–473), as enacted into law by section 1(a)(6)

9 of Public Law 106–554, is amended by striking ‘‘, to an

10 individual who receives’’ and all that follows before the

11 semicolon at the end and inserting ‘‘to an individual who

12 has received an organ transplant’’.

13 (b) EFFECTIVE DATE.—The amendments made by

14 this section shall apply to drugs furnished on or after the

15 date of enactment of this Act.

16 SEC. 3. PROVISION OF APPROPRIATE COVERAGE OF IM17 MUNOSUPPRESSIVE DRUGS UNDER THE

18 MEDICARE PROGRAM FOR ORGAN TRANS19 PLANT RECIPIENTS.

20 (a) CONTINUED ENTITLEMENT TO IMMUNO21 SUPPRESSIVE DRUGS.—

22 (1) KIDNEY TRANSPLANT RECIPIENTS.—Sec23 tion 226A(b)(2) of the Social Security Act (42

24 U.S.C. 426–1(b)(2)) is amended by inserting ‘‘(ex25 cept for coverage of immunosuppressive drugs under

26 section 1861(s)(2)(J))’’ after ‘‘shall end’’.
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1 (2) OTHER TRANSPLANT RECIPIENTS.—The

2 flush matter following paragraph (2)(C)(ii)(II) of

3 section 226(b) of the Social Security Act (42 U.S.C.

4 426(b)) is amended by striking ‘‘of this subsection)’’

5 and inserting ‘‘of this subsection and except for cov6 erage of immunosuppressive drugs under section

7 1861(s)(2)(J))’’.

8 (3) APPLICATION.—Section 1836 of the Social

9 Security Act (42 U.S.C. 1395o) is amended—

10 (A) by striking ‘‘Every individual who’’

11 and inserting ‘‘(a) IN GENERAL.—Every indi12 vidual who’’; and

13 (B) by adding at the end the following new

14 subsection:

15 ‘‘(b) SPECIAL RULES APPLICABLE TO INDIVIDUALS

16 ONLY ELIGIBLE FOR COVERAGE OF IMMUNOSUPPRESSIVE

17 DRUGS.—

18 ‘‘(1) IN GENERAL.—In the case of an individual

19 whose eligibility for benefits under this title has

20 ended except for the coverage of immunosuppressive

21 drugs by reason of section 226(b) or 226A(b)(2), the

22 following rules shall apply:

23 ‘‘(A) The individual shall be deemed to be

24 enrolled under this part for purposes of receiv25 ing coverage of such drugs.
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1 ‘‘(B) The individual shall be responsible

2 for the full amount of the premium under sec3 tion 1839 in order to receive such coverage.

4 ‘‘(C) The provision of such drugs shall be

5 subject to the application of—

6 ‘‘(i) the deductible under section

7 1833(b); and

8 ‘‘(ii) the coinsurance amount applica9 ble for such drugs (as determined under

10 this part).

11 ‘‘(D) If the individual is an inpatient of a

12 hospital or other entity, the individual is enti13 tled to receive coverage of such drugs under

14 this part.

15 ‘‘(2) ESTABLISHMENT OF PROCEDURES IN

16 ORDER TO IMPLEMENT COVERAGE.—The Secretary

17 shall establish procedures for—

18 ‘‘(A) identifying beneficiaries that are enti19 tled to coverage of immunosuppressive drugs by

20 reason of section 226(b) or 226A(b)(2); and

21 ‘‘(B) distinguishing such beneficiaries from

22 beneficiaries that are enrolled under this part

23 for the complete package of benefits under this

24 part.’’.
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1 (4) TECHNICAL AMENDMENT.—Subsection (c)

2 of section 226A of the Social Security Act (42

3 U.S.C. 426–1), as added by section 201(a)(3)(D)(ii)

4 of the Social Security Independence and Program

5 Improvements Act of 1994 (Public Law 103–296;

6 108 Stat. 1497), is redesignated as subsection (d).

7 (b) EXTENSION OF SECONDARY PAYER REQUIRE8 MENTS FOR ESRD BENEFICIARIES.—Section

9 1862(b)(1)(C) of the Social Security Act (42 U.S.C.

10 1395y(b)(1)(C)) is amended by adding at the end the fol11 lowing new sentence: ‘‘With regard to immunosuppressive

12 drugs furnished on or after the date of enactment of the

13 Comprehensive Immunosuppressive Drug Coverage for

14 Transplant Patients Act of 2001, this subparagraph shall

15 be applied without regard to any time limitation.’’.

16 (c) EFFECTIVE DATE.—The amendments made by

17 this section shall apply to drugs furnished on or after the

18 date of enactment of this Act.

19 SEC. 4. PLANS REQUIRED TO MAINTAIN COVERAGE OF IM20 MUNOSUPPRESSIVE DRUGS.

21 (a) APPLICATION TO CERTAIN HEALTH INSURANCE

22 COVERAGE.—

23 (1) IN GENERAL.—Subpart 2 of part A of title

24 XXVII of the Public Health Service Act (42 U.S.C.
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1 300gg–4 et seq.) is amended by adding at the end

2 the following:

3 ‘‘SEC. 2707. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.

4 ‘‘A group health plan (and a health insurance issuer

5 offering health insurance coverage in connection with a

6 group health plan) shall provide coverage of immuno7 suppressive drugs that is at least as comprehensive as the

8 coverage provided by such plan or issuer on the day before

9 the date of enactment of the Comprehensive Immuno10 suppressive Drug Coverage for Transplant Patients Act

11 of 2001, and such requirement shall be deemed to be in12 corporated into this section.’’.

13 (2) CONFORMING AMENDMENT.—Section

14 2721(b)(2)(A) of the Public Health Service Act (42

15 U.S.C. 300gg–21(b)(2)(A)) is amended by inserting

16 ‘‘(other than section 2707)’’ after ‘‘requirements of

17 such subparts’’.

18 (b) APPLICATION TO GROUP HEALTH PLANS AND

19 GROUP HEALTH INSURANCE COVERAGE UNDER THE EM20 PLOYEE RETIREMENT INCOME SECURITY ACT OF 1974.—

21 (1) IN GENERAL.—Subpart B of part 7 of sub22 title B of title I of the Employee Retirement Income

23 Security Act of 1974 (29 U.S.C. 1185 et seq.) is

24 amended by adding at the end the following new sec25 tion:
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1 ‘‘SEC. 714. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.

2 ‘‘A group health plan (and a health insurance issuer

3 offering health insurance coverage in connection with a

4 group health plan) shall provide coverage of immuno5 suppressive drugs that is at least as comprehensive as the

6 coverage provided by such plan or issuer on the day before

7 the date of enactment of the Comprehensive Immuno8 suppressive Drug Coverage for Transplant Patients Act

9 of 2001, and such requirement shall be deemed to be in10 corporated into this section.’’.

11 (2) CONFORMING AMENDMENTS.—

12 (A) Section 732(a) of the Employee Retire13 ment Income Security Act of 1974 (29 U.S.C.

14 1185(a)) is amended by striking ‘‘section 711’’

15 and inserting ‘‘sections 711 and 714’’.

16 (B) The table of contents in section 1 of

17 the Employee Retirement Income Security Act

18 of 1974 is amended by inserting after the item

19 relating to section 713 the following new item:

‘‘Sec. 714. Coverage of immunosuppressive drugs.’’.

20 (c) APPLICATION TO GROUP HEALTH PLANS UNDER

21 THE INTERNAL REVENUE CODE OF 1986.—Subchapter B

22 of chapter 100 of the Internal Revenue Code of 1986 is

23 amended—
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1 (1) in the table of sections, by inserting after

2 the item relating to section 9812 the following new

3 item:

‘‘Sec. 9813. Coverage of immunosuppressive drugs.’’;

4 and

5 (2) by inserting after section 9812 the fol6 lowing:

7 ‘‘SEC. 9813. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.

8 ‘‘A group health plan shall provide coverage of im9 munosuppressive drugs that is at least as comprehensive

10 as the coverage provided by such plan on the day before

11 the date of enactment of the Comprehensive Immuno12 suppressive Drug Coverage for Transplant Patients Act

13 of 2001, and such requirement shall be deemed to be in14 corporated into this section.’’.

15 (d) EFFECTIVE DATE.—The amendments made by

16 this section shall apply to plan years beginning on or after

17 January 1, 2002.

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