II 

113TH CONGRESS 

1ST SESSION S. 323 

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. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 13, 2013 

Mr. DURBIN (for himself and Mr. COCHRAN) 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 

for extended months of Medicare coverage of immunosuppressive drugs for kidney transplant patients and 

other renal dialysis provisions. 

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 Kidney Transplant 

6 Patients Act of 2013’’. 


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1 SEC. 2. EXTENDED MONTHS OF COVERAGE OF IMMUNO2 SUPPRESSIVE DRUGS FOR KIDNEY TRANS3 PLANT PATIENTS AND OTHER RENAL DIALY4 SIS PROVISIONS. 

5 (a) MEDICARE ENTITLEMENT TO IMMUNO6 SUPPRESSIVE DRUGS FOR KIDNEY TRANSPLANT RECIPI7 ENTS.— 

8 (1) KIDNEY TRANSPLANT RECIPIENTS.—Sec9 tion 226A(b)(2) of the Social Security Act (42 

10 U.S.C. 426–1(b)(2)) is amended by inserting ‘‘(ex11 cept for eligibility for enrollment under part B solely 

12 for purposes of coverage of immunosuppressive 

13 drugs described in section 1861(s)(2)(J))’’ before ‘‘, 

14 with the thirty-sixth month’’. 

15 (2) INDIVIDUALS ELIGIBLE ONLY FOR COV16 ERAGE OF IMMUNOSUPPRESSIVE DRUGS.— 

17 (A) Section 1836 of the Social Security 

18 Act (42 U.S.C. 1395o) is amended— 

19 (i) by striking ‘‘Every’’ and inserting 

20 ‘‘(a) IN GENERAL.—Every’’; and 

21 (ii) by inserting at the end the fol22 lowing new subsection: 

23 ‘‘(b) INDIVIDUALS ELIGIBLE FOR IMMUNO24 SUPPRESSIVE DRUG COVERAGE.—Beginning on January 

25 1, 2014, every individual whose insurance benefits under 

26 part A have ended (whether before, on, or after such date) 


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1 by reason of section 226A(b)(2) is eligible for enrollment 

2 in the insurance program established by this part solely 

3 for purposes of coverage of immunosuppressive drugs.’’. 

4 (B) CONFORMING AMENDMENT.—Sections 

5 1837, 1838, and 1839 of the Social Security 

6 Act (42 U.S.C. 1395(p), 42 U.S.C. 1395(q), 42 

7 U.S.C. 1395(r)) are each amended by striking 

8 ‘‘1836’’ and inserting ‘‘1836(a)’’ each place it 

9 appears. 

10 (3) ENROLLMENT FOR INDIVIDUALS ONLY ELI11 GIBLE FOR COVERAGE OF IMMUNOSUPPRESSIVE

12 DRUGS.—Section 1837 of the Social Security Act 

13 (42 U.S.C. 1395(p)) is amended by adding at the 

14 end the following new subsection: 

15 ‘‘(m)(1) Any individual who is eligible under section 

16 1836(b) to enroll in the medical insurance program estab17 lished under this part for purposes of coverage of immuno18 suppressive drugs may enroll only in such manner and 

19 form as may be prescribed by regulations, and only during 

20 an enrollment period described in this subsection. 

21 ‘‘(2) An individual described in paragraph (1) may 

22 enroll beginning on the first day of the third month before 

23 the month in which the individual first satisfies section 

24 1836(b). 


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1 ‘‘(3) An individual described in paragraph (1) whose 

2 entitlement for hospital insurance benefits under part A 

3 ends by reason of section 226A(b)(2) on or after January 

4 1, 2014, shall be deemed to have enrolled in the medical 

5 insurance program established by this part for purposes 

6 of coverage of immunosuppressive drugs.’’. 

7 (4) COVERAGE PERIOD FOR INDIVIDUALS ONLY

8 ELIGIBLE FOR COVERAGE OF IMMUNOSUPPRESSIVE

9 DRUGS.— 

10 (A) IN GENERAL.—Section 1838 of the So11 cial Security Act (42 U.S.C. 1395q) is amended 

12 by adding at the end the following new sub13 section: 

14 ‘‘(g) In the case of an individual described in section 

15 1836(b), the following rules shall apply: 

16 ‘‘(1) In the case of such an individual who is 

17 deemed to have enrolled in part B for coverage of 

18 immunosuppressive drugs under section 1837(m)(3), 

19 such individual’s coverage period shall begin on the 

20 first day of the month in which the individual first 

21 satisfies section 1836(b). 

22 ‘‘(2) In the case of such an individual who en23 rolls in part B for coverage of immunosuppressive 

24 drugs under section 1837(m)(2), such individual’s 

25 coverage period shall begin on the first day of the 


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1 month in which the individual first satisfies section 

2 1836(b) or the month following the month in which 

3 the individual so enrolls, whichever is later. 

4 ‘‘(3) The provisions of subsections (b) and (d) 

5 shall apply with respect to an individual described in 

6 paragraph (1) or (2). 

7 ‘‘(4) In addition to the reasons for termination 

8 under subsection (b), the coverage period of an indi9 vidual described in paragraph (1) or (2) shall end 

10 when the individual becomes entitled to benefits 

11 under this title under section 226(a), 226(b), or 

12 226A.’’. 

13 (B) CONFORMING AMENDMENTS.—Section 

14 1838(b) of the Social Security Act (42 U.S.C. 

15 1395q(b)) is amended, in the matter following 

16 paragraph (2), by adding ‘‘or section 

17 1837(m)(3)’’ after ‘‘section 1837(f)’’ each place 

18 it appears. 

19 (5) PREMIUMS FOR INDIVIDUALS ONLY ELIGI20 BLE FOR COVERAGE OF IMMUNOSUPPRESSIVE

21 DRUGS.—Section 1839 of the Social Security Act 

22 (42 U.S.C. 1395r) is amended— 

23 (A) in subsection (b), by adding at the end 

24 the following new sentence: ‘‘No increase in the 

25 premium shall be effected for individuals who 


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1 are enrolled pursuant to section 1836(b) for 

2 coverage only of immunosuppressive drugs.’’; 

3 and 

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

5 subsection: 

6 ‘‘(j) DETERMINATION OF PREMIUM FOR INDIVID7 UALS ONLY ELIGIBLE FOR COVERAGE OF IMMUNO8 SUPPRESSIVE DRUGS.—The Secretary shall, during Sep9 tember of each year, determine and promulgate a monthly 

10 premium rate for the succeeding calendar year for individ11 uals who enroll only for the purpose of coverage of im12 munosuppressive drugs under section 1836(b). Such pre13 mium shall be equal to 35 percent of the monthly actuarial 

14 rate for enrollees age 65 and over, determined according 

15 to paragraph (1), for that succeeding calendar year. The 

16 monthly premium of each individual enrolled for coverage 

17 of immunosuppressive drugs under section 1836(b) for 

18 each month shall be the amount promulgated in this sub19 section. Such amount shall be adjusted in accordance with 

20 subsections (c) and (f).’’. 

21 (6) GOVERNMENT CONTRIBUTION.—Section 

22 1844(a) of the Social Security Act (42 U.S.C. 

23 1395w(a)) is amended— 

24 (A) in paragraph (3), by striking the pe25 riod at the end and inserting ‘‘; plus’’; 


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

2 paragraph: 

3 ‘‘(4) a Government contribution equal to the es4 timated aggregate reduction in premiums payable 

5 under part B that results from establishing the pre6 mium at 35 percent of the actuarial rate under sec7 tion 1839(j) instead of 50 percent of the actuarial 

8 rate for individuals who enroll only for the purpose 

9 of coverage of immunosuppressive drugs under sec10 tion 1836(b).’’; and 

11 (C) by adding at the end the following 

12 flush matter: 

13 ‘‘The Government contribution under paragraph (4) 

14 shall be treated as premiums payable and deposited 

15 for purposes of subparagraphs (A) and (B) of para16 graph (1).’’. 

17 (7) EXTENSION OF SECONDARY PAYER RE18 QUIREMENTS FOR ESRD BENEFICIARIES ELIGIBLE

19 FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.— 

20 Section 1862(b)(1)(C) of the Social Security Act (42 

21 U.S.C. 1395(y)(b)(1)) is amended by adding at the 

22 end the following new sentence: ‘‘With regard to im23 munosuppressive drugs furnished to an individual 

24 who enrolls for the purpose of coverage of immuno25 suppressive drugs under section 1836(b) on or after 


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1 January 1, 2014, this subparagraph shall apply 

2 without regard to any time limitation, except that 

3 when such individual becomes entitled to benefits 

4 under this title under sections 226(a) or 226(b), or 

5 entitled to or eligible for benefits under this title 

6 under section 226A, the provisions of subparagraphs 

7 (A) and (B), and the time limitations under this 

8 subparagraph, respectively, shall apply.’’. 

9 (8) ENSURING COVERAGE UNDER THE MEDI10 CARE SAVINGS PROGRAM.—Section 1905(p)(1)(A) of 

11 the Social Security Act (42 U.S.C. 1396d(p)(1)(A)) 

12 is amended by inserting ‘‘or an individual who is en13 rolled under part B for the purpose of coverage of 

14 immunosuppressive drugs under section 1836(b)’’ 

15 after ‘‘section 1818’’. 

16 (9) PART D.—Section 1860D–1(a)(3)(A) of the 

17 Social Security Act (42 U.S.C. 1395w–101(a)(3)(A)) 

18 is amended by inserting ‘‘(but not including an indi19 vidual enrolled solely for coverage of immuno20 suppressive drugs under section 1836(b))’’ before 

21 the period at the end. 

Æ 


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