Survey: Part D isn't working for infusion

Sunday, December 31, 2006

A recent survey adds weight to arguments that home infusion therapy does not belong under Medicare Part D.
The National Home Infusion Association (NHIA) asked discharge planners about their experiences discharging dual-eligible patients under the benefit program that began Jan. 1, 2006.
"We think we know the problems coming from providers, but we very much wanted an independent assessment that was different," said Bruce Rodman, director of health information and policy for NHIA. "They are referral sources to providers and have a different viewpoint, and for those who might be skeptical, it increases credibility."
The survey asked discharge planners to list their top three problems--if any--rather than create a bias by providing a list to choose from.
The top three, in summary:
* The amount of time spent--as well as delays--verifying benefits, obtaining prior authorizations and exceptions; and no coverage for needed drug or drug not on formulary.
* Inability to locate home infusion providers in the patient's pharmacy drug plan network that can accept the patient if the patient cannot pay for the non-covered services, supplies and equipment.
* Part D does not cover services, supplies and equipment.
Rodman said the association will use the results to bolster advocacy efforts on Capitol Hill, including the Home Infusion Consolidated Coverage Act of 2006, which seeks to cover home infusion drugs, supplies and services under Medicare Part B.
"We've already shared the results with CMS to see what they can do within the limitations that Part D has set up for home infusion," said Rodman. "In general, the design of the program is not a fit for a medical benefit."
Although the survey focused on dual-eligible patients, Rodman said, similar difficulties were incurred by other Part D beneficiaries.
Rodman said the survey, conducted from Aug. 1 to Sept. 27, 2006, instructed participants to give a current assessment.
"CMS, in working with NHIA, had tried to get the service back for dual-eligibles to the same levels that they had prior to Part D," he said. "That has not worked."