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From 2019-2021, fewer than 1,300 Medicare beneficiaries used the home infusion benefit each calendar quarter—even though about 3.2 million patients are served each year by home infusion pharmacies. The National Home Infusion Association (NHIA) and other advocacy groups are working to pass the Preserving Patient Access to Home Infusion Act, a bill that would fix flaws in Medicare’s coverage, including adding pharmacy services. HomeCare talked with NHIA President and CEO Connie Sullivan about those efforts and other priorities for the organization and the home infusion industry as a whole.
HomeCare: The Preserving Patient Access to Home Infusion Act has been a major priority, right? How is work going on that?
SULLIVAN: It’s going well. We are seeing signs that the bill is moving forward; we are waiting for a Congressional Budget Office score and are receiving technical assistance from the Centers for Medicare & Medicaid Services (CMS). All of those things, we feel, are a positive sign that the bill is under serious consideration.
HomeCare: Is there anything else going on in Washington right now that you’re paying very close attention to?
SULLIVAN: Things going on in Washington? Always! I think the other thing that we are optimistic about is the Inflation Reduction Act, the capping of out-of-pocket costs for Medicare Part D for seniors that would start phasing in in 2024 and be fully implemented into 2025. That’ll reduce out-of-pocket spend for seniors who use some of these higher dollar home infusion drugs. If they want to have their infusions at home, their out-of-pocket will be more comparable to what they pay in a physician’s office under Part B. So that’s really encouraging and we’re really happy to see that. It doesn’t necessarily fix the coverage gap for Medicare Part D drugs—there’s still no coverage for services and supplies, and for a drug that costs $30,000 a month, a co-pay in the catastrophic range of 5% is not achievable for a lot of these patients, so it takes home infusion off the table. But I think that going forward with that cap in place will make home infusion more of an option for these patients, especially disabled patients for whom it’s a real effort to get out of their house to a clinic every day or every month.
HomeCare: The association has put a lot of energy into research collection and you’re now encouraging providers to collect race and demographic data. Why is that important?
SULLIVAN: As an industry, we just need to know if we’re reaching a diverse range of communities out there with our services. The first place to start is to understand your own situation. I think we are probably doing a good job, maybe better than some other health care services are, but we don’t have evidence of that. So we want to collect that data and just find out what the situation is from an equitability standpoint, and what story do we have to tell, or what improvements do we need to make?
HomeCare: Have you seen any indicators yet?
SULLIVAN: It’s probably a two-year cycle: One to issue a definition or categories that we recommend providers implement, then they have to implement and actually collect it. And then we can start to ask for that data through the foundation or our benchmarking programs. But we have seen some indicators; actually, CMS’s data for the Part B benefit indicates that we are serving the African American population at higher rates than their enrollment in Medicare. I felt like that was a really positive indication that we are reaching some diverse groups of patients—but I certainly don’t want to get ahead of ourselves and say we’re doing a good job. I think we can always probably do better.
HomeCare: And that data, if favorable, presumably can also help tell the story to Congress, to CMS and to payers as to the value of the industry.
SULLIVAN: Yes. I’m not going to say for sure we don’t have gaps. We’ve always known that from an economic diversity standpoint, we have a large percentage of managed Medicaid and we serve a wide range of patients from an economic standpoint. And I think there have sometimes been opponents of the home side of care saying, ‘Oh, it’s only for the wealthy,’ or, ‘You have to have a nice house,’ or something like that. That perception is very, very wrong and I don’t even know where that comes from, because it’s certainly not the case. There’s no economic bar that you have to achieve to have home infusion. In fact, I feel like these services are most important for people who are more reliant on being at work and not missing days. ... Or little things that we don’t think about: having to pay for parking if you go to a health system or something like that. I think the time component is really significant if you have a major illness and I think any time we can give back time to people who are trying to care for family members or keep their kids in school or be productive in the workforce is very important, valuable byproduct of home-based care.
