NHIA: New proposal fails to meaningfully address access gap to home infusion

ALEXANDRIA, Va. – The National Home Infusion Association (NHIA) says CMS’s new proposal to modify the criteria for the use of an infusion pump should not be viewed as a solution to the broader access challenges facing Medicare beneficiaries who could safely receive therapy at home. The association says it appreciates that CMS, in its 2027 Home Health Prospective Payment System Rate Update, recognized that registered nurses and other qualified clinicians are well-equipped to safely monitor and manage potential adverse effects associated with home infusion therapies, but it believes Congress needs to enact the Preserving Patient Access to Home Infusion Act, H.R. 2172 and S. 1058, to fully address the structural deficiencies in the home infusion benefit. “The limited impact of this proposal underscores the much larger disparity that continues to exist between Medicare and the commercial insurance market,” NHIA stated. “Today, over 350 infused drugs are routinely administered safely in patients' homes under commercial insurance coverage. By contrast, CMS acknowledges in the proposed rule that only a single drug is expected to newly qualify for Medicare coverage under the revised external infusion pump criteria. While NHIA supports expanding access for any beneficiary who may benefit from this policy, the proposal fails to meaningfully narrow the significant access gap between Medicare beneficiaries and commercially insured patients.” NHIA points out that the thousands of beneficiaries receiving intravenous anti-infectives, hydration, immune globulin, biologics and other infused medications will continue to be directed to hospital outpatient departments and skilled nursing facilities despite home infusion often being the clinically appropriate, lower-cost, and patient-preferred setting. CMS’s new proposal details the implementation of the Joe Fiandra Access to Home Infusion Act, which was passed earlier this year to expand Medicare coverage for certain home infusion therapies and require an external infusion pump and administration by a health care professional.