ALEXANDRIA, Virginia—The National Home Infusion Association (NHIA) held its annual Advocacy in Action Day on Nov. 6, during which association members and patients met with members of Congress and their staff to advocate for a fix to the Medicare home infusion coverage gap. Over the course of the event, NHIA members held more than 130 meetings in support of the Preserving Patient Access to Home Infusion Act (HR 2172 and S 1058).
NHIA members representing provider and supplier companies, along with patients who depend on home infusion services, participated in the event to share their experiences and discuss the critical need to modernize Medicare coverage for home infusion therapy.
“Home-based infusion is a proven, patient-preferred model that delivers safe, effective care while lowering costs and relieving pressure on hospitals and skilled facilities,” said Connie Sullivan, BSPharm, president and CEO of NHIA. “We’re grateful to our bipartisan champions—Reps. Vern Buchanan (R-FL), Debbie Dingell (D-MI), Diana Harshbarger (R-TN), Terri Sewell (D-AL) and Sens. Tim Scott (R-SC) and Mark Warner (D-VA)—for leading on this critical issue. NHIA will continue to fight for seniors who need timely access to home infusion services. It’s time for Medicare to evolve and catch up to the private sector, where patients can receive care in their preferred setting—the home—while reducing total health care costs.”
Why Action Is Needed
Medicare's current home infusion therapy (HIT) services benefit is limited to approximately 36 drugs that utilize infusion pumps for administration. According to NHIA, it does not provide adequate coverage for the pharmacy professional services that make home infusion possible. As a result, few home infusion pharmacies participate in the benefit, limiting access for seniors and individuals with disabilities. This contrasts with commercial insurance payers who make home infusion readily available for more than 300 unique drugs and biologics, including IV anti-infectives, which are among the most routinely used home therapies.
Each year, an estimated one million Medicare patients are diverted to outpatient departments or skilled nursing facilities to receive IV anti-infective therapies because of the existing coverage limitations. This not only increases overall health care costs but also restricts patient choice and access to timely, clinically appropriate care at home.
The Legislative Solution
The Preserving Patient Access to Home Infusion Act would modernize Medicare’s home infusion therapy benefit by closing existing coverage gaps and recognizing pharmacy professional services essential to the safe delivery of care in the home, as well as expanding care for Medicare beneficiaries who require IV anti-infective treatments. By aligning Medicare policy with the commercial insurance model, the legislation would ensure patients have access to home infusion services when clinically appropriate and reduce overall health care costs by allowing more patients to receive therapy in the most appropriate and cost-effective setting.