Sponsors (3)
The bill strengthens and stabilizes payments for dialysis drugs and ESRD services—improving patient access and provider financial predictability—but increases Medicare spending and creates risks of perverse incentives, payment misalignment, and added administrative burden.
Medicare beneficiaries receiving dialysis will have continued payment support for new dialysis drugs/biologics for at least three years, improving access to innovative therapies.
Hospitals and dialysis providers will receive more predictable and better-aligned payments (post‑TDAPA add‑on, annual inflation updates, and ESRD forecast corrections), reducing revenue uncertainty and shortfalls when drug prices or market costs rise.
Medicare beneficiaries on dialysis are likely to experience more stable local access to dialysis services because payments that better reflect cost changes reduce the risk providers face financial losses and service reductions.
Taxpayers and the Medicare program will face higher spending because add‑on payments and larger ESRD updates increase federal outlays for dialysis drugs and services.
Higher Medicare payments for dialysis drugs could indirectly translate into higher Medicare Advantage premiums or put pressure on the program to cut or limit other services.
Manufacturers and providers may have incentives to classify or promote use of drugs under the dialysis benefit to capture add‑on payments, which could increase utilization and program costs.
Based on analysis of 3 sections of legislative text.
Extends TDAPA for qualifying new renal dialysis drugs and creates a permanent post‑TDAPA add‑on (65% of per‑service spending) and a forecast error correction to ESRD payment updates starting in 2026.
Official title: Amend title XVIII of the Social Security Act to improve access to innovative treatment options for end-stage renal disease under the Medicare program, and for other purposes.
Introduced September 8, 2025 by Marsha Blackburn · Last progress September 8, 2025
Requires Medicare to continue paying the Transitional Drug Add‑On Payment Adjustment (TDAPA) for new renal dialysis drugs/biologics for at least three years and creates a new permanent post‑TDAPA add‑on payment for such products, calculated as 65% of average per‑service drug spending (updated for inflation) and applied when TDAPA ends. Also adds a mechanism to correct for forecast error in the annual ESRD payment update beginning with the 2026 update to better align payment updates with actual cost changes.