News and Updates

Medicare Advantage Plans May Consolidate Home Infusion Drugs Into Part C Benefit

(July 25, 2008)

CMS: Improved benefit coordination promotes continuity of care and cost avoidance of more expensive institutional care

The Centers for Medicare & Medicaid Services (CMS) has included in a Part D program manual directions on how Medicare Advantage (MA) plans may consolidate their benefit for provision of home infusion therapy.  Specifically, MA plans may provide home infusion drugs for coverage under Medicare Part C along with infusion services, supplies and equipment by providing “Part D home infusion drugs as part of a bundled service as a mandatory supplemental benefit under Part C.”

The agency says “this improved benefit coordination promotes continuity of care and cost avoidance of more expensive institutional care by facilitating continuous access to home infusion drugs, as well as the costs of administration and supplies associated with that therapy.”

For MA plans, it is an alternative to splitting out of the infusion drug coverage to its MA-PD plan in Part D separately from the other components of home infusion under Part C.

CMS first informed MA plans of this option in a letter on May 26, 2006 and has reiterated this several times since then.  The instructions are to be added to Chapter 6 of the agency’s Medicare Prescription Drug Benefit Manual as announced in a CMS Transmittal released on July 18, 2008.

Click here to read the full CMS instructions to MA plans.