Home IV providers make case for separate pharmacy status

Tuesday, January 31, 2006

HARRISBURG, Pa. - An education campaign engineered by Pennsylvania home infusion providers is close to convincing legislators that infusion pharmacies belong in a separate class from retail pharmacies.
A bill with that goal in mind won House approval in mid-December. Introduced last fall, H.B. 2202 was expected to be picked up when the Senate reconvened in January. If the bill passes, it would mean that regulatory or legislative rulings for pharmacies would treat infusion pharmacies separately from retail.
With Medicare Part D arriving that's important, says Dave Fiorini, executive director of the Pennsylvania Association of Medical Suppliers.
"There's a lot of changes happening to the pharmacy side of the Pennsylvania Program of All Inclusive Care for the Elderly program that are including infusion pharmacies, and it's not the same type of pharmacy," said Fiorini. The goal, he said, was to make lawmakers aware that across-the-board changes to pharmacies just don't work for the specialized services home infusion providers offer.
Representatives and senators visited home infusion pharmacies for a first-hand look at the process of preparing drugs. Once lawmakers realized the complexities involved, they were supportive, said Helen Michener, general manager of Critical Care Systems in Harrisburg, Pa.
"They went in the clean room and saw how we mix things, the sterile environment, the lab work to be monitored," said Michener. "It's just not the same process and (retail pharmacies) aren't legally expected to monitor the kinds of things we are."
The education push came about after Medicaid in August revised the payment for pharmaceuticals, from average sales price plus 6% to wholesale acquisition cost plus 7% for brand name drugs and WAC plus 66% for generics. Infusion providers argued that WAC pricing is often below their acquisition costs (See HME News, 10/05).
"We're different and we need to be reimbursed differently," said Michener. "We need to be able to cover our costs."