Infusion stakeholders urge changes to home infusion benefit

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Friday, February 14, 2020

WASHINGTON – The National Home Infusion Association and more than 250 stakeholders have asked CMS to overhaul home infusion therapy rules.

In a letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma, they ask CMS to model reimbursement for home infusion after the private sector, which pays for services each day an infusion drug is administered.

Under the Medicare Part B model, payment is only made for days in which a “skilled professional,” is in the home. Under CMS’s interpretation, reimbursement for services by pharmacists and other professionals are not recognized.

“Numerous studies indicate that patients overwhelmingly prefer the home over other sites of care—and when they receive home infusion services, they are highly satisfied,” said NHIA President & CEO Connie Sullivan, BSPharm. “We urge CMS to reconsider their flawed interpretation of the benefit, which negatively impacts the ability of patients to get the care they need.”

The letter also cites concerns with delays in access to new FDA-approved medications, which currently can take over a year under the local coverage determination reconsideration process; and emphasizes that a patient’s decision about where to receive infusion therapy should be the result of a dialogue between the physician and patient—particularly given the impact on a patients’ quality of life and out-of-pocket costs.

NHIA in February 2019 filed a lawsuit against HHS over its reimbursement model for home infusion services.