HOME INTRAVENOUS THERAPY

To support the continuation of a home intravenous therapy benefit under federal and private health insurance plans and expansion of the home infusion benefit under Medicare at an appropriate level of reimbursement for pharmacists’ patient care services provided, medications, supplies, and equipment. 

Rationale

The Medicare Modernization Act of 2003 created an outpatient prescription drug benefit for Medicare beneficiaries, Medicare Part D. The new benefit provided prescription drug coverage for Medicare beneficiaries by private health plans and pharmacy benefit managers (PBMs). Although the law requires certain basic coverage packages across the plan continuum, it provides no coverage for services and supplies used in home infusion. The result is that the drug products used in home infusion may be covered, but the supplies (e.g., IV bags, tubing) and services related to providing and administering the drug products are not.

The 21st Century Cures Act of 2016 redefined coverage for home infusion services, establishing a new benefit in Medicare Part B that covers professional services associated with home infusion. However, the new benefit does not take effect until 2021, and the current benefit reimbursement is far lower than the value of the services. Although there is a transitional gap program to slightly buffer providers from the low reimbursement rates, the cuts have taken a toll on home infusion providers, making it essential that CMS implement the higher reimbursement rate for 2021. ASHP also remains concerned that under the new Cures Act benefit, reimbursement is made only to the pharmacy, not the pharmacist. Continued advocacy is needed to allow pharmacists to bill directly for the benefit.