New Kidney Care Bill Guarantees Payment for Innovative Dialysis Drugs Starting 2026, Removes Budget Cap

The aptly named Kidney Care Access Protection Act is focused on making sure patients with end-stage renal disease (ESRD) can actually get the newest treatments, and that the people providing the care—dialysis centers and doctors—can afford to offer them. It’s a two-part bill: Title I tackles innovation payment, and Title II stabilizes the annual cost adjustments for providers.

The Upgrade Path: Permanent Payments for New Drugs

Title I is the big one for innovation. Currently, when the FDA approves a genuinely new dialysis drug or biological product, Medicare gives providers a temporary extra payment, called the Transitional Drug Add-On Payment Adjustment (TDAPA), to cover the cost while they integrate it. Think of it as seed money. This bill says that TDAPA payment must be extended for at least three years for qualifying products approved after January 1, 2020, and used starting in 2026. This gives facilities a solid window to adopt new treatments.

But here’s the game-changer: For drugs that start getting this temporary payment on or after January 1, 2024, the bill mandates a permanent add-on payment starting in 2026, right after the temporary period ends. This permanent rate is calculated based on the drug’s actual usage and sales data, and critically, it’s set at 65% of the calculated cost. Why is this a big deal? Because the bill explicitly states this permanent adjustment won't be implemented in a budget-neutral way. Translation: Medicare can’t offset the cost of these new payments by cutting funding somewhere else. For manufacturers and providers, this creates a clear, stable, and long-term financial incentive to bring innovative kidney treatments to market, which ultimately means more options for patients.

Making Sure the Tech Gets Paid For

It’s not just drugs; it’s equipment too. The bill extends the temporary payment adjustment for new and innovative equipment and supplies (TPNIES) for at least three years for devices furnished starting in 2026. If a device has the FDA’s “breakthrough device” designation, it automatically qualifies for this payment. Even more significant, the bill removes the rule that excluded capital-related assets—meaning major, expensive equipment—from receiving this temporary payment. If a dialysis center needs to buy a cutting-edge piece of machinery, they can now get the TPNIES payment to help cover that cost, making it easier for them to upgrade their tech.

This title also cleans up a payment headache with Medicare Advantage (MA) plans. Starting in 2026, the Secretary must make direct payments to providers for these new, transitional kidney therapies, ensuring that MA plans don't slow down the adoption of innovation by complicating payment for these specific items.

Stabilizing the Dialysis Budget

Title II addresses the financial stability of the dialysis centers themselves. Every year, Medicare adjusts the payment rates for dialysis services based on predicted cost increases, especially labor. Starting in 2026, this bill requires the government to look back and correct for past mistakes in those predictions. If the government’s forecast error was off by more than half a percentage point (0.5%) in the previous years (starting with 2021 and 2022 data), they must adjust the current year’s payment increase to make up the difference.

This is a win for stability. Dialysis centers rely on these annual updates to manage rising costs, and this correction mechanism ensures that if the government underestimates inflation or labor costs, providers aren't left holding the bag. For the average person, this means the local dialysis clinic is less likely to face sudden financial strain due to inaccurate federal cost projections, which helps ensure consistent access to care.