Bipartisan legislation easing financial strains on transplant recipients, live donors introduced in Senate.

Bipartisan legislation introduced last week in the House and Senate could ease financial strains on transplant recipients and living organ donors alike.

Under bills introduced by Senators Mike DeWine (R-OH) and Dick Durbin (D-IL), organ transplant recipients would receive lifetime Medicare coverage for their lifesaving immunosuppressive drugs and health insurers would be prohibited from raising premiums or imposing preexisting condition exclusions on living organ donors.

In a separate but related action, Representative Michael Bilirakis (R-FL) reintroduced legislation, passed by the House last year, containing funding for donor awareness programs and under certain circumstances paying travel and subsistence expenses for living donors.

The bills would effectively close loopholes that weaken Medicare coverage for organ recipients and severely limit insurance options for donors.

"Medicare treats transplant patients differently than other patients. The Medicare rules actually discriminate against transplant patients," said Senator Durbin in introducing the Comprehensive Immunosuppressive Drug Coverage for Transplant Patients Act of 2003 (S. 178). "For example, Medicare only pays for anti-rejection drugs for transplants performed in a Medicare-approved transplant facility. Most people are completely unaware of this fact and how it can jeopardize their future coverage of immunosuppressive drugs. Many are far too sick at the time of transplantation to research the intricate nuances of Medicare coverage policy."

Senator DeWine noted that he and Durbin worked together in 2000 to pass legislation extending coverage of immunosuppressive drugs which contained "loopholes to the coverage that would finally be closed" by the new bill.

In a press release Durbin noted the existence of the following loopholes:

*"Medicare does not pay for anti-rejection drugs for those patients who received their transplants prior to becoming a Medicare beneficiary. For instance, if a person receives an organ transplant at age 64 through his or her insurance plan, he/she loses immunosuppressive coverage when he/she retires and enrolls in Medicare for health coverage.

*Medicare pays for anti-rejection drugs only for transplants performed in a Medicare-approved transplant facility.

*End-Stage Renal Disease (ESRD) patients qualify for Medicare on the basis of their needing dialysis. If ESRD patients receive a kidney transplant, they only qualify for Medicare coverage for 3 years after their transplant."

Under S. 178 the new Medicare policy would remove the above limitations and extend coverage to all Medicare beneficiaries who have had a transplant for as long as they need the drugs.

Troy Zimmerman, director of Government Relations for the National Kidney Foundation, praised the senators' efforts on behalf of patients.

"In 2000, Congress greatly assisted transplant recipients by eliminating the 36 month time limitation for Medicare-aged and Medicare-disabled beneficiaries who had Medicare status at the time of transplant," Zimmerman told Transplant News. "However, gaps in coverage remain, including permanent immunosuppressive coverage for Medicare ESRD beneficiaries who are not Medicare-aged or Medicare-disabled, and coverage for beneficiaries who received their transplant prior to becoming Medicare-eligible. This legislation, if passed, would alleviate that disparity."

The Living Donor Protections Act (S. 186) contains provisions amending current protections contained in the Health Insurance Portability and Accountability Act assuring that living organ donors are not denied insurance nor are they subject to discriminatory premiums because of their living donor status.

"Quite simply, a brother who donates a part of his kidney to his sister should not be denied health insurance," DeWine said. "But tragically that is what often happens. Frequently, individuals who are living organ donors are denied health insurance or are restricted from the insurance market. Instead, we should celebrate living organ donors and remove obstacles and barriers for the successful donation of organs. Insurance shouldn't undermine someone's decision to be a living organ donor."

The bill would amend 3 acts to provide health insurance protections for individuals who are living organ donors-the Employee Retirement Income Security Act of 9174, the Public Health Service Act, and the Internal Revenue Code of 1986.

Bilirakis, the chairman of the House Subcommittee on Health, reintroduced the Organ Donation Improvement Act of 2003 (H.R. 399) on January 28.

The bill would allow the Secretary of the Department of Health and Human Services (HHS) to award grants or contracts to states, transplant centers, qualified organ procurement organizations, or other public entities to help cover expenses of people who volunteer to become live organ donors. Organizations receiving the funds would be allowed to pay for travel and subsistence costs and specified incidental costs incurred by living donors. The bill allocates $5 million a year appropriated for each of fiscal years 2004 through 2008.

Despite some criticism from transplant groups, the bill retains a rather convoluted formula for providing the assistance. For example, assistance could only be provided if the donor lives in a different state than the recipient and the recipient's annual income does not exceed $35,000 (may be adjusted for inflation in subsequent years).

The bill also authorizes $15 million for fiscal year 2004 for carrying the HHS Secretary to carryout public awareness studies and demonstrations. The funding may be used to make grants to public and nonprofit private entities to conduct studies and demonstration projects for increasing donation, make grants to states to carry out awareness campaigns including increasing living donation and study, develop or enhance donor registries.