NHIA rebuts MedPAC's infusion report

Friday, August 24, 2012

ALEXANDRIA, Va. – MedPAC, in a recent report to Congress, doesn’t put much stock in implementing a demonstration project to see whether or not there should be a more comprehensive benefit for home infusion therapy.

But the report, say stakeholders, is badly flawed.

“They obviously do not understand the role of infusion pharmacies,” said Russ Bodoff, executive director of the National Home Infusion Association (NHIA). “There’s very little discussion of services, which is one of the reasons a benefit is needed.”

In its report, MedPAC looked at issues related to payment for the therapy and whether creating a comprehensive benefit would better serve beneficiaries and save Medicare money. Medicare Part B covers a handful of infusion drugs,  services, supplies and equipment. Medicare Part D only pays for drugs.

In comments to the House Ways and Means Subcommittee on Health, NHIA criticized the report on several key points: that it overlooks the hardships and risk of infection for patients who receive infusion therapy in an institutional setting; that it wrongly concludes that a home infusion therapy benefit would drive up utilization; and that it dismisses the experience of private insurance and Medicare Advantage plans that illustrate that a significant number of patients can avoid costly hospitalization by receiving home infusion therapy.

“One thing they point out: They say private payers find savings because they use prior authorizations and Medicare doesn’t,” said Bodoff. “If there are ways to reduce costs and improve efficiencies, why doesn’t Medicare learn from the private sector?”

Stakeholders believe they have a strong case and plan to keep pushing for a demo, Bodoff said.