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Currently, Medicare only covers certain home infusion drugs and biologicals administered intravenously, or subcutaneously, while commercial payors cover patients for an expansive array of intravenous and subcutaneous drugs. Lifting Medicare regulations, will ensure that Medicare enrollees in need of home infusion therapy can receive the care they need in a more comfortable environment and at a more reasonable cost to the federal government. This would provide increased access to care for patients with immune diseases, cancer, serious infections, heart failure, and other conditions that might otherwise force patients to receive their care in a more expensive and less convenient hospital, outpatient clinic, or skilled facility. This legislation is vital to home infusion patients, allowing them to safely receive treatment in the setting they overwhelmingly prefer—their homes.

“Home infusion providers have the capacity to treat hundreds-of-thousands of patients as hospitals and nursing facilities are being pushed to capacity,” said National Home Infusion Association (NHIA) Board Chair Logan Davis, PharmD, MBA. “Regardless of any change in policy, the home infusion community is working with health care providers to bring their resources to bare and keep the most vulnerable patients at home. While this can be a challenge for patients in traditional Medicare — where coverage is limited — the home infusion community is committed to playing a vital role in addressing this public health emergency.”

As per the NHIA, more than 160 hospitals, patient groups, and other stakeholders are calling on Medicare to lift restrictions on home infusion. They have announced their support for concept legislation that would: 

  • Cover Home Infusion Equipment, Supplies, and Professional Services.
  • Adequately Reimburse Providers.
  • Maintain Current Drug and Home Health Reimbursement.

“Our focus has always been to improve post-acute care coordination and care management, to help reduce gaps in patient care, and to enhance the overall patient experience,” said Keith Hartman, RPH, COO of ContinuumRx. “As a response to the pandemic, we have seen the rapid shift from moving care out of the hospital to home, are experiencing and measuring the success rates, and foresee that this is the model for the future. By lifting the current Medicare restrictions the door is opened to offer a higher quality of care and reduction in rehospitalization rates.”