II 

109TH CONGRESS 

1ST SESSION S. 173 

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 

JANUARY 26, 2005 

Mr. DEWINE (for himself and Mr. DURBIN) 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 2005’’. 
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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)) is amended 

6 by striking ‘‘, to an individual who receives’’ and all that 

7 follows before the semicolon at the end and inserting ‘‘to 

8 an individual who has received an organ transplant’’. 

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

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

11 date of enactment of this Act. 

12 SEC. 3. PROVISION OF APPROPRIATE COVERAGE OF IM13 MUNOSUPPRESSIVE DRUGS UNDER THE 

14 MEDICARE PROGRAM FOR ORGAN TRANS15 PLANT RECIPIENTS. 

16 (a) CONTINUED ENTITLEMENT TO IMMUNO17 SUPPRESSIVE DRUGS.— 

18 (1) KIDNEY TRANSPLANT RECIPIENTS.—Sec19 tion 226A(b)(2) of the Social Security Act (42 

20 U.S.C. 426–1(b)(2)) is amended by inserting ‘‘(ex21 cept for coverage of immunosuppressive drugs under 

22 section 1861(s)(2)(J))’’ after ‘‘shall end’’. 

23 (2) OTHER TRANSPLANT RECIPIENTS.—The 

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

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

26 426(b)) is amended by striking ‘‘of this subsection)’’ 
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1 and inserting ‘‘of this subsection and except for cov2 erage of immunosuppressive drugs under section 

3 1861(s)(2)(J))’’. 

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

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

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

7 and inserting ‘‘(a) IN GENERAL.—Every indi8 vidual who’’; and 

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

10 subsection: 

11 ‘‘(b) SPECIAL RULES APPLICABLE TO INDIVIDUALS

12 ONLY ELIGIBLE FOR COVERAGE OF IMMUNOSUPPRESSIVE

13 DRUGS.— 

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

15 whose eligibility for benefits under this title has 

16 ended except for the coverage of immunosuppressive 

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

18 following rules shall apply: 

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

20 enrolled under this part for purposes of receiv21 ing coverage of such drugs. 

22 ‘‘(B) The individual shall be responsible 

23 for the full amount of the premium under sec24 tion 1839 in order to receive such coverage. 
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1 ‘‘(C) The provision of such drugs shall be 

2 subject to the application of— 

3 ‘‘(i) the deductible under section 

4 1833(b); and 

5 ‘‘(ii) the coinsurance amount applica6 ble for such drugs (as determined under 

7 this part). 

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

9 hospital or other entity, the individual is enti10 tled to receive coverage of such drugs under 

11 this part. 

12 ‘‘(2) ESTABLISHMENT OF PROCEDURES IN

13 ORDER TO IMPLEMENT COVERAGE.—The Secretary 

14 shall establish procedures for— 

15 ‘‘(A) identifying beneficiaries that are enti16 tled to coverage of immunosuppressive drugs by 

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

18 ‘‘(B) distinguishing such beneficiaries from 

19 beneficiaries that are enrolled under this part 

20 for the complete package of benefits under this 

21 part.’’. 

22 (4) TECHNICAL AMENDMENT.—Subsection (c) 

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

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

25 of the Social Security Independence and Program 
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1 Improvements Act of 1994 (Public Law 103–296; 

2 108 Stat. 1497), is redesignated as subsection (d). 

3 (b) EXTENSION OF SECONDARY PAYER REQUIRE4 MENTS FOR ESRD BENEFICIARIES.—Section 

5 1862(b)(1)(C) of the Social Security Act (42 U.S.C. 

6 1395y(b)(1)(C)) is amended by adding at the end the fol7 lowing new sentence: ‘‘With regard to immunosuppressive 

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

9 Comprehensive Immunosuppressive Drug Coverage for 

10 Transplant Patients Act of 2005, this subparagraph shall 

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

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

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

14 date of enactment of this Act. 

15 SEC. 4. PLANS REQUIRED TO MAINTAIN COVERAGE OF IM16 MUNOSUPPRESSIVE DRUGS. 

17 (a) APPLICATION TO CERTAIN HEALTH INSURANCE

18 COVERAGE.— 

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

20 XXVII of the Public Health Service Act (42 U.S.C. 

21 300gg–4 et seq.) is amended by adding at the end 

22 the following: 

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

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

25 offering health insurance coverage in connection with a 
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1 group health plan) shall provide coverage of immuno2 suppressive drugs that is at least as comprehensive as the 

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

4 the date of enactment of the Comprehensive Immuno5 suppressive Drug Coverage for Transplant Patients Act 

6 of 2005, and such requirement shall be deemed to be in7 corporated into this section.’’. 

8 (2) CONFORMING AMENDMENT.—Section 

9 2721(b)(2)(A) of the Public Health Service Act (42 

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

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

12 such subparts’’. 

13 (b) APPLICATION TO GROUP HEALTH PLANS AND

14 GROUP HEALTH INSURANCE COVERAGE UNDER THE EM15 PLOYEE RETIREMENT INCOME SECURITY ACT OF 1974.— 

16 (1) IN GENERAL.—Subpart B of part 7 of sub17 title B of title I of the Employee Retirement Income 

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

19 amended by adding at the end the following new sec20 tion: 

21 ‘‘SEC. 714. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS. 

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

23 offering health insurance coverage in connection with a 

24 group health plan) shall provide coverage of immuno25 suppressive drugs that is at least as comprehensive as the 
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1 coverage provided by such plan or issuer on the day before 

2 the date of enactment of the Comprehensive Immuno3 suppressive Drug Coverage for Transplant Patients Act 

4 of 2005, and such requirement shall be deemed to be in5 corporated into this section.’’. 

6 (2) CONFORMING AMENDMENTS.— 

7 (A) Section 732(a) of the Employee Retire8 ment Income Security Act of 1974 (29 U.S.C. 

9 1191(a)) is amended by striking ‘‘section 711’’ 

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

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

12 the Employee Retirement Income Security Act 

13 of 1974 is amended by inserting after the item 

14 relating to section 713 the following new item:

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

15 (c) APPLICATION TO GROUP HEALTH PLANS UNDER

16 THE INTERNAL REVENUE CODE OF 1986.—Subchapter B 

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

18 amended— 

19 (1) in the table of sections, by inserting after 

20 the item relating to section 9812 the following new 

21 item:

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

22 and 

23 (2) by inserting after section 9812 the fol24 lowing: 
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1 ‘‘SEC. 9813. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS. 

2 ‘‘A group health plan shall provide coverage of im3 munosuppressive drugs that is at least as comprehensive 

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

5 the date of enactment of the Comprehensive Immuno6 suppressive Drug Coverage for Transplant Patients Act 

7 of 2005, and such requirement shall be deemed to be in8 corporated into this section.’’. 

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

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

11 January 1, 2006.

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