FOR IMMEDIATE RELEASE
Alexandria, VA (February 3, 2026) —The 2026 government funding for Health and Human Services that passed the House of Representatives today includes a change to the qualifying criteria for drugs under Medicare’s home infusion benefit that may expand access to certain health care provider-administered drugs if an infusion pump is required for administration. Passage of H.R. 4993, the Joe Fiandra Access to Home Infusion Act, reflects Congress’ recognition of the strong patient interest—including among individuals with rare diseases—in home infusion access.
Earlier in January, members of the House Energy and Commerce Health Subcommittee also expressed strong bipartisan support for The Preserving Patient Access to Home Infusion Act (H.R. 2172) which would remove barriers to accessing home infusion by establishing coverage for the full scope of professional services that make the benefit function and allow access for patients needing IV anti-infectives, with or without the use of an infusion pump.
The Joe Fiandra Access to Home Infusion Act creates a path to coverage under the Part B Durable Medical Equipment, Prosthetic Devices, Prosthetics, Orthotics, & Supplies (DMEPOS) benefit for a narrow set of drugs that require a health care provider and an infusion pump for administration. The current DMEPOS home infusion benefit is limited to approximately 40 drugs and lacks a payment for pharmacy services, which has limited provider participation in the program. By comparison, all other payors utilize a bundled payment model to cover all services and supplies and allow access to over 300 infusion drugs without restrictions for the use of a pump or a limitation on payments for services unless they are delivered face to face.
NHIA calls on Congress to continue work on expanding home infusion access and to urgently pass the Preserving Patient Access to Home Infusion Act. This bipartisan legislation— which enjoys support from dozens of stakeholder organizations–includes critical reforms that will ensure beneficiaries living in rural areas and those with disabilities who depend on home access can find a qualified provider.
“I am encouraged by the momentum in Congress to address the limited access to home infusion that exists for Medicare patients. For too long, Medicare has lagged other payors that have recognized the benefits of offering straightforward access to home infusion rather than directing patients to higher-cost settings for infusions. Congress needs to take the next step and pass H.R. 2172 and finally establish a benefit that reflects how care is actually delivered,” said Connie Sullivan, BSPharm, NHIA President and CEO. “We are ready to support Congress in their efforts to finally fix the broken Medicare home infusion benefit.”
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National Home Infusion Association (NHIA) is a trade association that represents companies accredited to provide medically necessary infusion therapies to patients with acute and chronic health conditions, as well as companies that manufacture and supply infusion related products and services. Infusion therapy involves patient-specific compounded medications, supplies, and a range of pharmacy, nursing, and other clinical services for delivering care to patients in the home or suite setting.
NHIA commends CMS for listening to stakeholders and deciding not to move forward at this time with the proposed changes to HCPCS codes and billing units for immune globulin products.
This proposal to modify the criteria for the use of an infusion pump should not be viewed as a solution to the broader access challenges facing Medicare beneficiaries who could safely receive infusion therapy at home.
NHIA submitted comments to CMS on a new proposed rule on interoperability and prior authorization for drugs. While NHIA is mostly supportive of standardizing prior authorization (PA) processes for Medicare-covered drugs, it wants CMS to know that home infusion may not fit neatly into processes designed for medical and pharmacy benefits.
