Medicare Part D

NHIA is currently requesting its members to take action regarding the Medicare Part B home infusion reimbursement issue regarding CMS’ July 2, 2018 proposed rule.

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Join us in urging CMS to modify the proposed rule that jeopardizes the January 2019 implementation of the home infusion therapy services temporary transitional payment as well as the permanent payment to go into effect January 2021.

The Issue

Medicare covers infusion therapy when provided in a hospital, nursing home, and in the home for a select number of drugs under the Part B Durable Medical Equipment (DME) benefit. The program currently does not fully cover infusion therapy for infusion drugs that are reimbursed through the Medicare Part D program. Requiring beneficiaries to go into costlier institutional settings to receive infusion treatments subjects them to considerable risk of secondary health care acquired infections.

Home infusion coverage in the Medicare program is split between Parts B and D. Under the Medicare Part B Durable Medical Equipment (DME) benefit, home infusion professional services, drugs and supplies are covered due to provisions included in the 21st Century Cures Act and the Bipartisan Budget Act of 2018. However, a gap still exists for the coverage of home infusion professional services and supplies for home infusion drugs in Part D. While approximately 40 home infusion drugs are covered in the Medicare Part B DME benefit, approximately 100 home infusion drugs in the Medicare Part D prescription drug program still need the same coverage for services and supplies. The majority of Part D home infusion drugs are infused antibiotics, which are necessary to treat vulnerable beneficiaries with diabetic foot ulcers, cystic fibrosis, post-surgical infections, among other health conditions. Importantly, the new bill will use the same services reimbursement structure that already exists in Part B to bridge the services gap for home infusion drugs covered by Part D.

 

Take Action!

Join us in supporting legislation to improve the quality of Medicare coverage for seniors that need infused drug therapies.

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Access Resources

Utilize NHIA Resources to make your voice heard.

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