U.S. Sens. Bill Cassidy, MD, R-La., and Dick Durbin, D-Ill., introduced legislation on Feb. 28 that would extend immunosuppressive drug coverage for Medicare patients who receive a kidney transplant regardless of age.
“Current law only covers Medicare Part B kidney transplant recipients for 36 months after a transplant occurs, meaning patients who lack other coverage after 36 months would have to cover the costs out of pocket,” according to a press release from Cassidy’s office. “Many people ration their medications or stop taking their drugs and end up back in kidney failure and on dialysis.
“The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act (S. 3353) would do away with that time limit ensuring that individuals who received a kidney transplant paid for by Medicare do not have to worry about coverage for medications and protect their transplant ... Ensuring transplant patients have access to these medicines prevents complications, improves outcomes and saves taxpayer dollars,” according to the release.
The House and Senate bills would only extend Medicare coverage for immunosuppressive drugs. Patients with private insurance would not be eligible.
Americans with diagnosed ESKD qualify for Medicare regardless of age and have lifetime Medicare coverage as a dialysis patient. If they receive a kidney transplant, however, Medicare covers the cost of the organ procurement and surgery, along with immunosuppressive drugs for 36 months. Eligibility ends for the patient after that period unless they are older than 65 years old or are disabled, according to the release.
Sens. Joni Ernst, R-La., Jeanne Shaheen, D-N.H., Sheldon Whitehouse, D-R.I., and Todd Young, R-Ind., joined Cassidy and Durbin as co-sponsors of the legislation. The bill is similar to H.R. 5534, The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019, introduced by House members Ron Kind, D-Wis., and Michael Burgess, R-Texas, in early January.
Similar bills have been introduced yearly in Congress dating back to 2013 without passing both houses of Congress. However, President Donald J. Trump recently included a proposal to cover the cost of the drugs for Medicare patients in his 2020 spending bill and two government-issued reports released in May 2019 concluded that providing lifetime coverage of the drugs would save the government money. One report from the Office of the Assistant Secretary for Planning and Evaluation of the HHS noted extending the coverage would result in an accumulated savings of approximately $73 million in 10 years; a second report from the CMS Office of the Actuary showed a savings of $300 million in 10 years.
Both the House and Senate versions of the bill propose an implementation date of Jan. 1, 2022, but offer provisions to cover Medicare patients if they receive a kidney transplant before that date. The Senate bill calls for a study by the Comptroller General on the implementation of the Act to address any “program integrity issues,” due no later to Congress than Jan. 1, 2024.