Proposed legislation that would cover home-based infusion therapy for Medicare beneficiaries could save the healthcare system approximately $80 million over 10 years and provide access to life-saving care at patients’ homes. The potential savings is outlined in a report released in June by Avalere.
Representatives Eliot Engel (D-New York) and Pat Tiberi (R-Ohio) recently introduced The Medicare Home Infusion Site of Care Act (H.R. 5435), which would allow Medicare Part B coverage of home-based infusion-related care and services, including equipment and supplies.
“The current Medicare exclusion for in-home infusion must be corrected. Patients battling cancer or suffering from a serious infection should be able to receive quality care, at a lower cost, in their home,” said Congressman Engel. “Under the current guidelines patients must go elsewhere for treatment….This puts them at higher risk for infection, and treatment costs are usually far higher than if the therapy were provided at the patients’ home.”
At the moment, infusion therapy is fully covered by Medicare for patients in the hospital, skilled nursing facilities, hospital outpatient departments, and physician offices. The Medicare fee-for-service program is the only major payer that will not cover all essential components of home infusion therapy, such as infusion-related services, equipment, and supplies needed for therapy administration. Most infusion drugs are covered though.
“Ironically, patients who have access to this benefit under their private plans lose their coverage when they enroll in Medicare,” said Congressman Tiberi. “This is unfortunate and unnecessary.”
This bill is supported by the National Home Infusion Association, which represents organizations that provide infusion and specialized pharmacy products.
“Medicare patients with serious illnesses requiring IV therapy should not be excluded from in-home infusion when deemed appropriate by their physicians,” said Jack Rosenberg, PharmD, PhD, professor emeritus, Pharmacy Practice and Pharmacology, Long Island University, Brooklyn, NY, and Drug Topics’ editorial advisor.