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Temporary Fix Urged for Medicare’s Home Infusion Therapy Coverage

By Mike Stankiewicz | January 5, 2018

(Bloomberg Law) — If lawmakers don’t jump-start Medicare coverage for home infusion therapy starting in 2019 some companies might stop offering such services, an industry group told Congress.

The Immune Deficiency Foundation, in a Jan. 9 letter to Hill leaders, said Congress needs to pass a bill (S.1738) that would create a temporary Medicare payment the vital at-home drug service because of an “unintended loophole” in the 21st Century Cures Act.

The 2016 law cut the reimbursement for home infusion drugs from an average wholesale price to an average sales price, but promised a new Medicare home infusion benefit starting in 2021. The group says the four-year gap between the reimbursement change and the new coverage benefit is hurting vulnerable patients. A health-care consulting firm agreed.

“This gap is cutting patients off from at-home infusion services, which will now need to be done in hospitals,” Dana Macher, vice president of reimbursement at the consulting firm Avalere Health, told Bloomberg Law Thursday. “The last thing you want to do is send more people to the hospital, if you can avoid it.”

The foundation says Congress needs to issue the fix soon, because the Medicare agency has said it needs one year to implement the policy.