Medicare locks in permanent dialysis drug markups—no cost controls attached
S. 2730 — Kidney Care Access Protection Act · Filed by Marsha Blackburn (R-TN) · 2 cosponsors · Introduced Sep 8, 2025 · Referred to committee
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What it does
This bill extends and expands Medicare payment protections for new kidney dialysis drugs, biologics, and equipment. It guarantees that new dialysis drugs approved since 2020 receive temporary price add-ons for at least 3 years, then a permanent 65% add-on payment after that period ends. It also extends similar protections to new dialysis equipment and makes Medicare Advantage plans match these payments. The bill aims to ensure dialysis providers can afford to offer newer treatments without budget cuts elsewhere.
Why we flagged it
The bill's core function is to lock in above-market reimbursement rates for dialysis drugs and equipment by establishing permanent add-on payments that are not subject to budget-neutral adjustments or cost-effectiveness review. This directly benefits dialysis providers and pharmaceutical manufacturers.
What the text implies
- The 65% permanent add-on is calculated from utilization and average sales price but is NOT adjusted for clinical efficacy, comparative effectiveness, or whether the new drug is actually better than existing options—only that it is 'new.'
- The bill explicitly exempts the permanent add-on from 'budget neutral' adjustments and case-mix adjustments, meaning costs are NOT offset by reductions elsewhere in the ESRD payment system, creating direct Medicare spending increases.
- By requiring Medicare Advantage plans to match these payments, the bill forces private insurers to absorb the same above-market rates, potentially raising premiums for MA enrollees.
- The 'forecast error adjustment' in Section 201 retroactively corrects 2021–2022 payment shortfalls, effectively giving dialysis providers a backdated payment boost unrelated to current clinical or economic conditions.
- The AY modifier requirement (Section 104) creates a tracking mechanism for comorbid-disease drugs, but the bill's definition of what counts as 'renal dialysis services' vs. comorbid treatment is ambiguous and may lead to billing disputes or gaming.
Who it affects
Kidney dialysis patients may gain access to newer treatments if providers stock them, but the bill guarantees high reimbursement rates without cost controls, shifting costs to Medicare (and ultimately taxpayers and other beneficiaries). The permanent 65% add-on is not tied to clinical benefit or cost-effectiveness, creating open-ended spending.
Who stands to gain
- dialysis service providers (DaVita, Fresenius Medical Care, Renal Care Group)
- pharmaceutical manufacturers (Amgen, Vifor Pharma, Keryx Biopharmaceuticals, others with ESRD drugs)
- dialysis equipment manufacturers
Named in the bill
HHS Secretary, FDA, Medicare, Medicare Advantage, ESRD (End-Stage Renal Disease), Dialysis providers, Pharmaceutical manufacturers, Section 413.234 (CFR), Section 413.236 (CFR), Section 1881 (Social Security Act), Section 1853 (Social Security Act), Transitional Drug Add-On Payment Adjustment (TDAPA) — and 1 more
Where it stands
2 cosponsors: 1 Democrats, 1 Republicans.
- Sep 8, 2025 — Introduced · Congress.gov: “Introduced in Senate”
- Sep 8, 2025 — Referred to Senate Committee on Finance · Congress.gov: “Read twice and referred to the Committee on Finance”
Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.
Money around this bill
13 lobbying clients named this bill on 18 disclosure filings across 3 quarters, Dec 2025 to Jun 2026. Those filings disclosed $5,810,000 in lobbying spend. A filing names 4 bills on average, so that figure is what each filing reported, not a share belonging to this bill.
More lobbying clients named this bill than 94% of bills with at least one filing.
Marsha Blackburn, the sponsor, reported $133,620 in PAC receipts in the 2026 cycle.
- Fresenius Medical Care North America — $2,410,000 on 2 filings
- Davita Inc — $980,000 on 1 filing
- Dialysis Patient Citizens — $750,000 on 2 filings
- American Kidney Fund — $410,000 on 2 filings
- Cormedix Inc. — $380,000 on 1 filing
Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.
How this was measured
Analysis — Quorum's AI read the full bill text on Jul 6, 2026; transparency and hidden-provision scores are compared against the median of 16,222 analysed bills.
Status and sponsors — Congress.gov's bill record — actions, committee referrals and cosponsors — loaded nightly. The timeline shows status changes, not every procedural action.
Money — Senate Lobbying Disclosure Act filings whose specific-issue field names this bill for quarters ending Dec 2025 to Jun 2026. A filing's amount is reported whole beside the median number of bills a filing names; it is never divided across them. PAC receipts are FEC-reported contributions to the sponsor's candidate committee in the 2026 cycle.
As of — lobbying records through Jul 20, 2026 · page rendered 2026-10-20.
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