II 

108TH CONGRESS 

1ST SESSION S. 191

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 a kidney transplant, and for other 

purposes. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 16, 2003

Mr. DEWINE 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 a kidney transplant, 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,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Immunosuppressive 

5 Drug Coverage Act of 2003’’. 
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•S 191 IS 

1 SEC. 2. PROVISION OF APPROPRIATE COVERAGE OF IM2 MUNOSUPPRESSIVE DRUGS UNDER THE 

3 MEDICARE PROGRAM. 

4 (a) CONTINUED ENTITLEMENT TO IMMUNO5 SUPPRESSIVE DRUGS FOR KIDNEY TRANSPLANT RECIPI6 ENTS.—

7 (1) IN GENERAL.—Section 226A(b)(2) of the 

8 Social Security Act (42 U.S.C. 426–1(b)(2)) is 

9 amended by inserting ‘‘(except for coverage of im10 munosuppressive drugs under section 

11 1861(s)(2)(J))’’ after ‘‘shall end’’. 

12 (2) APPLICATION.—In the case of an individual 

13 whose eligibility for benefits under title XVIII of the 

14 Social Security Act (42 U.S.C. 1395 et seq.) has 

15 ended except for the coverage of immunosuppressive 

16 drugs by reason of the amendment made by para17 graph (1), the following rules shall apply: 

18 (A) The individual shall be deemed to be 

19 enrolled in part B of the original medicare fee20 for-service program under title XVIII of the So21 cial Security Act (42 U.S.C. 1395j et seq.) for 

22 purposes of receiving coverage of such drugs. 

23 (B) The individual shall be responsible for 

24 the full part B premium under section 1839 of 

25 such Act (42 U.S.C. 1395r) in order to receive 

26 such coverage. 
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•S 191 IS 

1 (C) The provision of such drugs shall be 

2 subject to the application of—

3 (i) the part B deductible under section 

4 1833(b) of such Act (42 U.S.C. 1395l(b)); 

5 and 

6 (ii) the coinsurance amount applicable 

7 for such drugs (as determined under such 

8 part B). 

9 (D) If the individual is an inpatient of a 

10 hospital or other entity, the individual is enti11 tled to receive coverage of such drugs under 

12 such part B. 

13 (3) ESTABLISHMENT OF PROCEDURES IN

14 ORDER TO IMPLEMENT COVERAGE.—The Secretary 

15 of Health and Human Services shall establish proce16 dures for—

17 (A) identifying beneficiaries that are enti18 tled to coverage of immunosuppressive drugs by 

19 reason of the amendment made by paragraph 

20 (1); and 

21 (B) distinguishing such beneficiaries from 

22 beneficiaries that are enrolled under part B of 

23 title XVIII of the Social Security Act for the 

24 complete package of benefits under such part. 
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•S 191 IS 

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

2 of section 226A (42 U.S.C. 426–1), as added by sec3 tion 201(a)(3)(D)(ii) of the Social Security Inde4 pendence and Program Improvements Act of 1994 

5 (Public Law 103–296; 108 Stat. 1497), is redesig6 nated 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 Immunosuppressive Drugs Coverage Act of 2003, this 

14 subparagraph shall be applied without regard to any time 

15 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. 3. 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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•S 191 IS 

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 Immunosuppressive Drug 

10 Coverage Act of 2003, and such requirement shall be 

11 deemed to be incorporated into this section.’’. 

12 (2) CONFORMING AMENDMENT.—Section 

13 2721(b)(2)(A) of the Public Health Service Act (42 

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

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

16 such subparts’’. 

17 (b) APPLICATION TO GROUP HEALTH PLANS AND

18 GROUP HEALTH INSURANCE COVERAGE UNDER THE EM19 PLOYEE RETIREMENT INCOME SECURITY ACT OF 1974.—

20 (1) IN GENERAL.—Subpart B of part 7 of sub21 title B of title I of the Employee Retirement Income 

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

23 amended by adding at the end the following new sec24 tion: 
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•S 191 IS 

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 Immunosuppressive Drug 

8 Coverage Act of 2003, and such requirement shall be 

9 deemed to be incorporated into this section.’’. 

10 (2) CONFORMING AMENDMENTS.—

11 (A) Section 732(a) of the Employee Retire12 ment Income Security Act of 1974 (29 U.S.C. 

13 1185(a)) is amended by striking ‘‘section 711’’ 

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

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

16 the Employee Retirement Income Security Act 

17 of 1974 is amended by inserting after the item 

18 relating to section 713 the following new item:

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

19 (c) APPLICATION TO GROUP HEALTH PLANS UNDER

20 THE INTERNAL REVENUE CODE OF 1986.—Subchapter B 

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

22 amended—
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•S 191 IS 

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 Immunosuppressive Drug 

12 Coverage Act of 2003, and such requirement shall be 

13 deemed to be incorporated into this section.’’. 

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

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

16 January 1, 2004.

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