I 

109TH CONGRESS 

1ST SESSION H. R. 2051

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 an organ transplant 

and whose entitlement to coverage would otherwise expire, and for other 

purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 3, 2005

Mr. CAMP (for himself and Mr. STRICKLAND) 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 the 

Workforce, 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 an organ transplant and whose 

entitlement to coverage would otherwise expire, and for 

other purposes.

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

2 This Act may be cited as the ‘‘Comprehensive Im3 munosuppressive Drug Coverage for Transplant Patients 

4 Act of 2005’’. 

5 SEC. 2. PROVISION OF APPROPRIATE COVERAGE OF IM6 MUNOSUPPRESSIVE DRUGS UNDER THE 

7 MEDICARE PROGRAM FOR ORGAN TRANS8 PLANT RECIPIENTS. 

9 (a) CONTINUED ENTITLEMENT TO IMMUNO10 SUPPRESSIVE DRUGS.—

11 (1) KIDNEY TRANSPLANT RECIPIENTS.—Sec12 tion 226A(b)(2) of the Social Security Act (42 

13 U.S.C. 426–1(b)(2)) is amended by inserting ‘‘(ex14 cept for coverage of immunosuppressive drugs under 

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

16 (2) OTHER TRANSPLANT RECIPIENTS.—The 

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

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

19 426(b)) is amended by striking ‘‘of this subsection)’’ 

20 and inserting ‘‘of this subsection and except for cov21 erage of immunosuppressive drugs under section 

22 1861(s)(2)(J))’’. 

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

24 Security Act (42 U.S.C. 1395o) is amended—
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1 (A) by striking ‘‘Every individual who’’ 

2 and inserting ‘‘(a) IN GENERAL.—Every indi3 vidual who’’; and 

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

5 subsection: 

6 ‘‘(b) SPECIAL RULES APPLICABLE TO INDIVIDUALS

7 ONLY ELIGIBLE FOR COVERAGE OF IMMUNOSUPPRESSIVE

8 DRUGS.—

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

10 whose eligibility for benefits under this title has 

11 ended except for the coverage of immunosuppressive 

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

13 following rules shall apply: 

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

15 enrolled under this part for purposes of receiv16 ing coverage of such drugs. 

17 ‘‘(B) The individual shall be responsible 

18 for the full amount of the premium under sec19 tion 1839 in order to receive such coverage. 

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

21 subject to the application of—

22 ‘‘(i) the deductible under section 

23 1833(b); and 
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1 ‘‘(ii) the coinsurance amount applica2 ble for such drugs (as determined under 

3 this part). 

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

5 hospital or other entity, the individual is enti6 tled to receive coverage of such drugs under 

7 this part. 

8 ‘‘(2) ESTABLISHMENT OF PROCEDURES IN

9 ORDER TO IMPLEMENT COVERAGE.—The Secretary 

10 shall establish procedures for—

11 ‘‘(A) identifying beneficiaries that are enti12 tled to coverage of immunosuppressive drugs by 

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

14 ‘‘(B) distinguishing such beneficiaries from 

15 beneficiaries that are enrolled under this part 

16 for the complete package of benefits under this 

17 part.’’. 

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

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

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

21 of the Social Security Independence and Program 

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

23 108 Stat. 1497), is redesignated as subsection (d). 

24 (b) EXTENSION OF SECONDARY PAYER REQUIRE25 MENTS FOR ESRD BENEFICIARIES.—Section 
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1 1862(b)(1)(C) of the Social Security Act (42 U.S.C. 

2 1395y(b)(1)(C)) is amended by adding at the end the fol3 lowing new sentence: ‘‘With regard to immunosuppressive 

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

5 Comprehensive Immunosuppressive Drug Coverage for 

6 Transplant Patients Act of 2005, this subparagraph shall 

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

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

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

10 date of enactment of this Act. 

11 SEC. 3. PLANS REQUIRED TO MAINTAIN COVERAGE OF IM12 MUNOSUPPRESSIVE DRUGS. 

13 (a) APPLICATION TO CERTAIN HEALTH INSURANCE

14 COVERAGE.—

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

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

17 300gg–4 et seq.) is amended by adding at the end 

18 the following: 

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

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

21 offering health insurance coverage in connection with a 

22 group health plan) shall provide coverage of immuno23 suppressive drugs that is at least as comprehensive as the 

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

25 the date of enactment of the Comprehensive Immuno-
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1 suppressive Drug Coverage for Transplant Patients Act 

2 of 2005, and such requirement shall be deemed to be in3 corporated into this section.’’. 

4 (2) CONFORMING AMENDMENT.—Section 

5 2721(b)(2)(A) of the Public Health Service Act (42 

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

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

8 such subparts’’. 

9 (b) APPLICATION TO GROUP HEALTH PLANS AND

10 GROUP HEALTH INSURANCE COVERAGE UNDER THE EM11 PLOYEE RETIREMENT INCOME SECURITY ACT OF 1974.—

12 (1) IN GENERAL.—Subpart B of part 7 of sub13 title B of title I of the Employee Retirement Income 

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

15 amended by adding at the end the following new sec16 tion: 

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

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

19 offering health insurance coverage in connection with a 

20 group health plan) shall provide coverage of immuno21 suppressive drugs that is at least as comprehensive as the 

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

23 the date of enactment of the Comprehensive Immuno24 suppressive Drug Coverage for Transplant Patients Act 
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1 of 2005, and such requirement shall be deemed to be in2 corporated into this section.’’. 

3 (2) CONFORMING AMENDMENTS.—

4 (A) Section 732(a) of the Employee Retire5 ment Income Security Act of 1974 (29 U.S.C. 

6 1185(a)) is amended by striking ‘‘section 711’’ 

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

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

9 the Employee Retirement Income Security Act 

10 of 1974 is amended by inserting after the item 

11 relating to section 713 the following new item:

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

12 (c) APPLICATION TO GROUP HEALTH PLANS UNDER

13 THE INTERNAL REVENUE CODE OF 1986.—Subchapter B 

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

15 amended—

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

17 the item relating to section 9812 the following new 

18 item:

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

19 and 

20 (2) by inserting after section 9812 the fol21 lowing: 

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

23 ‘‘A group health plan shall provide coverage of im24 munosuppressive drugs that is at least as comprehensive 
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1 as the coverage provided by such plan 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 (d) EFFECTIVE DATE.—The amendments made by 

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

8 January 1, 2006.

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