Sponsors (3)
The bill improves access to new dialysis therapies and stabilizes provider revenues by increasing and better aligning dialysis‑related payments, but does so at the cost of higher Medicare spending, incentives that may raise utilization and costs, and potential payment misalignments without patient‑level adjustments.
Medicare beneficiaries receiving dialysis will have more reliable access to new dialysis drugs and biologics because the bill extends predictable payment support (includes a multi‑year add‑on after TDAPA and explicit support for new therapies).
Hospitals, dialysis facilities, and providers will face less revenue uncertainty when adopting new dialysis therapies because of a predictable post‑TDAPA add‑on payment (a defined percentage of drug spending) and annual adjustments that help preserve payment value.
ESRD/dialysis payments will better track market realities — annual forecast‑error corrections and a mechanism for updates reduce the likelihood of persistent underpayment as costs rise, helping stabilize dialysis service availability.
Taxpayers and Medicare beneficiaries face higher federal Medicare spending because the bill increases add‑on payments and raises ESRD updates to correct prior underestimates, which could raise program costs and indirectly pressure premiums or other program priorities.
Manufacturers and providers may have stronger financial incentives to classify or promote drugs for use under the dialysis benefit to capture add‑on payments, which could increase utilization and overall program costs.
Because the bill does not include patient‑level case‑mix adjustments, payments may be misaligned with individual clinical needs, risking overpayment for some patients and underpayment for others and creating unfair incentives.
Based on analysis of 3 sections of legislative text.
Extends TDAPA for new renal dialysis drugs for at least three years, creates a permanent post‑TDAPA add‑on (65% of per‑service drug spending) and adds a forecast error adjustment to ESRD updates starting 2026.
Introduced September 8, 2025 by Marsha Blackburn · Last progress September 8, 2025
Requires Medicare to pay the transitional drug add‑on (TDAPA) for new renal dialysis drugs or biologics for at least three years and then create a permanent post‑TDAPA add‑on payment for those drugs. It also requires an annual “forecast error” correction to the ESRD (renal dialysis) annual update beginning in 2026 when projected and actual price changes diverge by more than 0.5 percentage points.