The Beneficiary Improvements and Protection Act (BIPA, or Public Law 106-554) provides a significant enhancement in Medicare coverage for immunosuppressive (anti-rejection) medications needed by transplant recipients. The Health Care Financing Administration (HCFA) issued a Program Memorandum on January 24,2001 that indicates how it plans to implement this expanded coverage. 

How does the Beneficiary Improvements and Protection Act differ from the legislation that was passed in 1999?  It covers the same categories of patients, but extends lifetime coverage to them. Significantly, the new benefit is not limited to transplants that were performed after a specified date, as was the case in the Balanced Budget Refinement Act of 1999.

The Medicare benefit has been extended to include the Medicare beneficiaries who had their coverage extended to 44 months in 1999 to have drug coverage for the life of their transplant with the changes enacted in 2000 .The new legislation does not expand an entitlement to more people, it extends a benefit for those who are already entitled. 

Who is covered by the new legislation?  All transplant recipients whose transplant was initially covered by Medicare or those who will receive such a transplant in the future and who meet either of these criteria:

• Age 65 or over; or
• Disabled according to Medicare. Anyone who receives SSDI meets the Medicare definition of disabled. Most kidney transplant patients who are considered disabled will likely have severe diabetes or hypertension, but theoretically could be collecting SSDI for a back injury or some other disability and qualify for transplant coverage as a result of their disability.

What kinds of transplants does this include?  Medicare pays for some heart, lung, and liver transplants if the recipients are aged 65 or disabled. Heart, lung, and liver transplant recipients whose transplant was covered by Medicare will be eligible for indefinite drug coverage, as well as kidney transplant recipients who meet age or disability requirements.

Who is not covered by the enhanced benefit?  Anyone who is entitled to Medicare based solely on the diagnosis of ESRD.

How many people will this extension affect?  According to estimates from the Institute of Medicine, more than 34,000 people will have extended coverage in 2001, growing to more than 44,500 people in 2004.

What about kidney transplant recipients whose Medicare entitlement is based solely on ESRD?  These people will continue to receive drug coverage for 36 months after their transplant.

When does the coverage go into effect?  The effective date of the coverage is December 21, 2000 when it was signed by President Clinton. (Since BIPA was an act of Congress it cannot be unilaterally rescinded by President Bush. ) However, the implementation date of the coverage is April 1, 2001. Although claims cannot be processed until after April 1, they can be filed immediately and will be retroactive to December 21, 2000.

How do I get this coverage?  If you meet the eligibility requirements, you should bring that to the attention of the pharmacy or other organization who currently provides your immunosuppressant drugs, and request that the organization process payment for the drugs according to the new law. If you are denied coverage, you may contact the appropriate Medicare agent for your region of the country.  If you need information regarding Regional Medicare services, you may contact HCFA at www.hcfa.gov or call 1-800-MEDICARE.