Home infusion stakeholders press for fix

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Thursday, January 26, 2017

WASHINGTON – More than 170 home infusion stakeholders signed a letter asking lawmakers to fix the “damaging” reimbursement gap created by the 21st Century Cures Act.

The letter, which was spearheaded by the National Home Infusion Association, has the support of home infusion providers, patient advocacy groups and healthcare systems, including the Cleveland Clinic, Johns Hopkins and Northwestern.

“The home is a safe, cost-effective site of care for delivering high-quality infusion care and is considered the preferred site of care by physicians and patients alike,” said Tyler Wilson, president & CEO of the NHIA. “Heart failure patients and those living with primary immunodeficiency diseases are particularly impacted by the shift in drug reimbursement. Until the gap in reimbursement is fixed, these already fragile beneficiaries may be forced to undergo treatment in an institutional setting where they are at a higher risk of infection and their quality of life is diminished.”

A provision in the Cures Act modifies the payment structure for certain infusion drugs under the Part B benefit, drastically reducing their reimbursement. The modification, which went into effect Jan. 1, essentially means that payments now cover only drug costs, not clinical services. Another provision in the act provides payments for these clinical services, but not until 2021.

Earlier this week, Option Care and other leading home infusion providers and the NHIA launched Keep My Infusion Care at Home, a coalition to press lawmakers to address the payment gap.