Part D headaches plague infusion providers

Friday, March 31, 2006

WASHINGTON - The new Medicare Part D drug benefit comes up so woefully short when reimbursing for home infusion therapy, say providers, that some have begun reducing the services they offer patients.
"There are very well established standards of care out there regarding how to treat home infusion patients and Part D doesn't recognize those things," said Lorrie Kline Kaplan, executive director of the National Home Infusion Association. "Just because Part D doesn't cover them doesn't mean they don't exist anymore."
Part D covers drugs plus a small dispensing fee most providers say is inadequate. Additionally, the benefit does not cover supplies like pumps and flushes, as well as compounding and support services, creating a money-loser and leaving patients at risk.
While Part D technically covers infusion drugs, it varies by plan as to which make it onto formularies. Many don't--a problem when multiple drugs are often needed. What's more, drugs covered in one circumstance may not be covered when prescribed for a different diagnosis or dosing schedule.
Retail pharmacies lack the knowledge to fill the gap, say providers, who have heard stories of patients receiving uncompounded drugs without support services or skilled nursing care.
That's unacceptable, say infusion providers.
"We've made the decision we will not do that," said Deb Holman, director of infusion services for Genesys Health Services in Flint, Mich. "We need to compound these drugs and provide them in the same manner that we would provide for any other patient."
What's more, lack of skilled support services compromises patient safety.
"We don't want the liability of infections," said Holman. "There's too much risk for contamination and sepsis."
There are some tasks, however, that could be passed on to patients.
"We're going to end up sending syringes and directions for how to draw it up," said Gary Schroeder senior manager of pharmacy services for Home Care Medical in New Berlin, Wis. Schroeder acknowledged the inconvenience to patients but couldn't justify giving away services.
With so many different plans in each state--Wisconsin alone has 45--many providers are simply throwing up their hands.
"Infusion providers just can't be providers for all of them," said Holman.
Providers who haven't yet signed with any part D plans say they will probably do so--in a limited manner--despite the financial drawbacks.