Home infusion stakeholders: Fix the gap

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Friday, January 27, 2017

WASHINGTON – Home infusion stakeholders want a fast fix for a payment gap that will limit patient access to therapy.

The National Home Infusion Association spearheaded a Jan. 26 letter, with more than 170 signatures, urging lawmakers to take “quick action” to address the payment gap.

“We can’t waste any time,” said Ken van Pool, vice president of legislative affairs for the NHIA. “Without a fix in the near-term, it just spirals out of control over time.”

As of Jan. 1, per a provision in the 21st Century Cures Act, Medicare pays for Part B infusion drugs under an average sales price model, a move that reduces payments so drastically that, essentially, they no longer cover services. Another provision in the act provides payments for these services, but not until 2021.

Signers to the NHIA’s letter ranged from providers and patient advocacy groups to prestigious healthcare systems, including the Cleveland Clinic, Johns Hopkins and Northwestern, said van Pool.

“I think this is sending a clear statement that this is a wide-ranging problem that’s been caused by the Cures bill,” he said.

Also last week, Option Care, a leading home infusion provider, along with NHIA and other industry leaders, launched Keep My Infusion Care at Home, a coalition charged with sharing stories of the impact of the changes, all with the patient front and center.

“These are patients that are late stage heart failure patients, or awaiting transplants or other procedures,” said Paul Mastrapa, CEO of Option Care. “The website for Keep My Infusion Care at Home makes it very easy for all involved to help make sure their representatives in Congress hear about this and address it as quickly as possible.”

There is already a “lot of noise” on the Hill about the payment gap, says Mastrapa.

“Leadership in the House and Senate are on record as recognizing that this is a problem and they are committed to fixing this issue,” he said.

With the new legislative session only a few weeks old, it’s too soon to identify a possible legislative vehicle for the issue, says van Pool. All eyes are currently on efforts to repeal and replace the Affordable Care Act.

“That’s the first train leaving the station, but we are looking for any train that could capture this,” he said. “That’s what we are working toward.”