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Summary of S. 631, the Immunosuppressive Drugs Coverage Act of 1999

Background

Immunosuppressive Coverage

In 1986, Congress expanded Medicare Part B to include coverage of immunosuppressive drugs for beneficiaries who had transplants that were eligible for Medicare coverage. In 1993, Congress passed legislation that gradually increased the length of coverage to 36 months following a transplant. The 36 month limit became fully effective in 1998. Individuals who receive an organ transplant need to take immunosuppressive drugs for the rest of their lives.

End-Stage Renal Disease Program

Individuals with End-State Renal Disease (ESRD) who meet certain conditions, including individuals who are not otherwise eligible for Medicare, are entitled to Medicare coverage through the ESRD program. However, for those individuals who are not otherwise entitled to Medicare coverage, the entitlement to Medicare ends 36 months following a transplant. As a result, these individuals lose all Medicare coverage.

Medicare as Secondary Payer

For Medicare beneficiaries who are working and have employer-provided health insurance, Medicare pays secondarily to the employer plan. For ESRD beneficiaries with employer health insurance, Medicare is the secondary payer only for 30 months. After 30 months, Medicare becomes the primary payer.

Summary of S. 631

The bill would:

Eliminate the 36 month time limit on the coverage of immunosuppressive drugs following a transplant so that Medicare would cover these drugs as long as the beneficiary needs them.
Continue only the entitlement to immunosuppressive drugs for those ESRD beneficiaries who lose their Medicare coverage 36 months following a transplant.
Permanently extend the Medicare Secondary Payer requirements for ESRD beneficiaries with respect to immunosuppressive drugs.

These provisions would apply to drugs furnished on or after the date of enactment.

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