Should Congress extend federal coverage of kidney failure medication?
H.R. 5074 extends payment assistance options for Medicare and Medicaid patients who suffer from End-Stage Renal Disease (ESRD), or kidney failure. Currently, federal coverage of such treatment options is set to expire in January 2025, but this bill would extend that deadline until 2033, subject to review pending FDA approval of potential new treatment options. Sponsor: Rep. Earl L. Carter (Republican, Georgia, District 1)
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Opponents say
At the time of research and publication, no official opposing statements have been identified. This does not mean that nobody opposes the bill, nor does it mean that opposing statements will not be made in the future.
Proponents say
• "With the new beneficiary out-of-pocket cap in the Medicare Part D program and the expanded eligibility for the low-income subsidy, the affordability of Part D drugs is further enhanced. Keeping coverage of oral-only ESRD drugs in the Part D program makes sense in terms of patient affordability and maintaining patient access to treatments. The Kidney PATIENT Act (H.R. 5074) is bipartisan legislation that would delay the move of oral-only ESRD drugs into the ESRD bundle until 2033 or until new intravenous therapies come to the market. The bill would ensure patients have access to the medications they and their doctors have determined work best for them. In addition, the bill would save money for taxpayers because it would delay an increase in the ESRD base rate that determines the bundled payment that would occur when adding oral-only drugs to the bundle." Source: American Kidney Fund
• "Our goal is to ensure that underserved and minoritized racial and ethnic communities receive optimal health care and we encourage policymakers and elected officials to embrace that objective. Patients on dialysis overcome many hurdles to obtain optimal care and the burden is even greater for members of historically disenfranchised population and patient cohorts…We applaud Representatives Buddy Carter, Ann McLane Kuster, Carol Miller, and Terri Sewell for taking action to preserve access to quality care for all patients on dialysis by sponsoring legislation to delay implementation of the inclusion of oral-only phosphate lowering therapies in the Medicare ESRD prospective payment system. We urge their colleagues to support passage this year." Source: Dr. Gary A. Puckrein (President and CEO, National Minority Quality Forum Action Network)
• "I was thrilled to see the Kidney PATIENT Act pass nearly unanimously out of the Ways and Means Committee and be one step closer to becoming law. This bill will provide patients with access to oral-only kidney disease therapies through their Medicare Part D benefit until 2027. Bipartisan support of the Kidney PATIENT Act from the Ways and Means Committee shows how important it is to take care of ESRD patients across the country…I look forward to the bill continuing to move forward in the House of Representatives." Source: Rep. Carol Miller (Republican, West Virginia, District 1)
- Rep. Sewell’s Kidney PATIENT Act Passes Out of the House Ways and Means Committee (Press Release)
- Medicare Names First 10 Drugs up for Price Negotiations With the Government (NBC)
- Biden Administration Starts Negotiations Over Medicare Drug Prices – Here’s How Prices Might Be Affected (Forbes)
- Kidney Patients Raise National Health Alert on Phosphorus (American Association of Kidney Patients)
- Medicare Partial Part B Benefit for Immunosuppressive Drugs (VeryWell Health)
- Rep. Earl L. Carter’s Largest Donors (OpenSecrets)
