Immuno Bill Passes After 20 Years

For the past 20 years, the AST has been advocating and working for passage of the Immuno Bill (officially known as the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act). At long last, after 20 years of hard work, hope, and disappointment, this legislation has finally become law.  Many of us understand the gravity of this moment. Despite continuous advocacy efforts for nearly two decades, we have all too often watched as this key legislation failed to reach the President’s desk.  Most importantly, we have been forced to watch as our patients struggled to take care of their kidney transplants because of the inherently flawed current law.

The Immuno Bill: A Brief History

For a patient to qualify for Medicare, they must be over the age of 65, be disabled, or have kidney disease. In 2000, Congress passed a law that gave lifelong immunosuppressive coverage to those over 65 or disabled. However, this left younger kidney recipients who were not considered disabled out of lifelong coverage. Instead, the law offered coverage of medications for just 36 months following a kidney transplant.

A patient with kidney disease has their dialysis treatments paid 100% by Medicare. Medicare will also pay for a kidney transplant. However, until the Immuno Bill passed, these kidney recipients only received immunosuppressive drug coverage for 36 months after transplant. If a recipient did not have alternative health insurance or did not otherwise qualify for Medicare, they lost their medication coverage.

The problem was obvious, as these medications are required for the life of the transplant and for the past two decades, the AST advocated to end the arbitrary 36-month limit and to include lifelong coverage in this policy.  While the bill has been introduced several times, until now, it only passed in the House of Representatives one time in 2010 but failed to advance in the Senate.

In December 2019, the Immuno Bill was introduced in the House of Representatives by Representatives Ron Kind (D-WI) and Michael Burgess, M.D. (R-TX), along with Anna Eshoo (D-CA), Jason Smith (R-MO), Donald McEachin (D-VA), and Jaime Herrera Beutler (R-WA). The bill passed the House on Tuesday, December 8, 2020. Prior to the bill’s passage, it was marked-up and approved by the House Energy & Commerce Committee on July 15, 2020.  During the mark-up, Congressman Michael Burgess M.D. (R-TX) publicly thanked the AST for the organization’s many years of staying the course for patients and seeking to pass this critical legislation.

  The Bill Makes Sense – So Why Did It Take So Long?

The Immuno Bill has enjoyed widespread support over the last ten sessions of Congress, but as we know, lifelong immunosuppressive coverage comes with a price tag.  During the 116th Congress, the Congressional Budget Office (CBO) determined that the Immuno Bill would not only help recipients and protect the gift of life; It would also save the federal government money. At present, the Immuno Bill is estimated to save American taxpayers approximately $400 million dollars.

The AST’s Involvement

It has been a challenging 20 years, but the AST was committed to seeing this through. Over the last two decades, we have worked to get our community involved, and I would be remiss if I did not mention these specific efforts.

• AST leaders testified in-person in front of key Congressional committees in support of the Immuno Bill

• The Society hosted more than a dozen Congressional staff briefings to educate members of Congress and their staff on the importance of this legislation

• The AST hosted multiple Congressional award receptions on Capitol Hill to honor and recognize more than two dozen Congressional champions that led the Immuno efforts in the House and Senate

• The AST coordinated many Capitol Hill D.C. fly-ins with patients, transplant professionals, recipients, living donors, and families

• A record-breaking level of grassroots activities over the last two years focused exclusively on the passage of the Immuno Bill was observed. Thank you to all of our AST members and transplant community members that really stepped up during a pandemic to let your voices be heard on Capitol Hill

• AST’s Government Relations team in Washington, D.C., worked tirelessly for nearly two decades to educate, cultivate, and mobilize the support of Congressional leaders and the Executive Branch to advance the patient-centric Immuno Bill

Immuno Bill: Congressional Leader Champions – Bipartisan & Bicameral Efforts to Victory

In a time where there is so much division in a highly charged partisan political environment, my faith is occasionally restored when I look at public policy efforts such as the Immuno Bill.  For nearly two decades, there has been a strong bipartisan and bicameral cast of dedicated and committed members in the House and Senate (and their staff) that have worked tirelessly to introduce, reintroduce, secure cosponsors, hold hearings, convene mark-ups, consideration, and passage on the floor. Every year, both parties on both sides of the Capitol stepped up to keep the Immuno Bill relevant and in play in the House and Senate. The AST and the transplant community cannot thank our bill sponsors enough for their many years of support and for never giving up on transplant patients.

During this 116th Congress, the Immuno Bill enjoyed the support of primary bill sponsors Senator Bill Cassidy, M.D. (R-LA), Senator Dick Durbin (D-IL), Rep. Michael Burgess, M.D. (R-TX), and Rep. Ron Kind (D-WI). The AST is forever indebted to these Congressional leaders for their many years of seeking to pass the Immuno Bill.  Over the last two decades, the Immuno Bill has resulted in many members of Congress, from both parties, working across the aisle to secure immunosuppressive drug coverage for transplant patients in desperate need of their anti-rejection medications. Many of these elected officials have worked closely with the AST and have expressed their strong support and resolve, frequently providing keynote speeches at AST meetings.

Over the years, we have had many bipartisan champions that have sought final passage of the Immuno Bill.  Some of these champions included: Senator Mike Dewine (now Governor of Ohio); Congressman Jay Inslee (now Governor of Washington); former Senator Ted Kennedy; and former Senator Bill Frist.

Our Deepest Appreciation to Bill Applegate

These efforts would not have been possible without the ongoing work of AST’s Government Relations Director, Bill Applegate, and his team members, Chris Rorick and Clare Chmiel. For nearly twenty years, Bill has been AST's eyes, ears, and boots on the ground proudly representing the AST on Capitol Hill. His work has brought countless opportunities to the Society, giving us the chance to meet directly with legislators. Furthermore, his efforts resulted in the AST’s participation in high profile events – including the signing of the HOPE Act with President Obama and President Trump's briefing on advancing kidney health. He believes in the Society’s mission and can always goes above and beyond in his commitment to making positive change for the transplant community. We would not be where we are today without his commitment, knowledge, and passion for his work.

Bill has guided the AST through each step of the way advocating for the Immuno Bill. He has provided countless hours of education for AST members and leaders, community members, and partners. Thanks to Bill, the AST successfully coordinated several D.C. fly-ins, meetings, and grassroots efforts.

Bill graduated from Radford University with a degree in political science and government. He began his career as an aide in the United States Senate and worked in several government affairs roles before joining Bryan Cave and taking AST on as a client in 2007.

In 2013, the St. Louis Business Journal selected Bill as one of its "40 Under 40" top young professionals in the business community.

Bill Applegate and the entire Government Relations team deserve our deepest gratitude. Bill, congratulations on this huge success - I look forward to celebrating with you in person!

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