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Your Guide to living well, Judy Joyce, MSW

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MEDICARE, MEDICAID, AND SCHIP BENEFITS IMPROVEMENT AND PROTECTION ACT OF 2000

On December 21, 2000 President Clinton signed the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA). Section 113 of this Act provides for the elimination of the time limitation on Medicare benefits for immunosuppressive drugs.

The effective date for this lifetime coverage for eligible transplant recipients is also December 21, 2000.

Following is the criteria for eligibility for those transplant recipients who will have access to Medicare lifetime coverage for immunosuppressants through BIPA on or after December 21, 2000:
  • Have received an organ transplant type (kidney, heart, liver, lung, pancreas) which was Medicare "covered" at the time of transplant
  • Have received their transplant in a Medicare approved facility
  • Have a transplanted organ which remains viable and requires immunosuppressant therapy
  • Be entitled to Medicare due to age or disability
  • Maintain Medicare B premium payments

Medicare beneficiaries who meet the above criteria will receive lifetime coverage for immunosuppressive drugs furnished on or after December 21, 2000.

Those recipients who received a kidney transplant and had Medicare entitlement only due to ESRD, and have not become entitled to Medicare due to age or disability, will NOT be eligible for lifetime coverage.

NOTE: This legislation also removed the provision in section 227 of the Balanced Budget Refinement Act of 1999 (BBRA) which set forth a one-time extension of the immunosuppressive drug benefit to Part B beneficiaries whose initial drug benefits would expire during the 5-year period between January 1, 2000 and December 31, 2004. This provision is no longer applicable. But, those who were eligible for the one-time extension will now be eligible for Medicare lifetime coverage effective December 21, 2000. This lifetime coverage is critically important to all transplant recipients and has been long awaited.

PharmaCare will be billing Medicare on behalf of our customers to quickly and efficiently allow access to this new coverage. If you have any further questions regarding this legislation please call us at 1-800-238-7828, extension 58125.

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