August 8, 2022

Rep. Earl L. “Buddy” Carter (R-GA.), one of two pharmacists in Congress, penned an op-ed, “Four years later, Medicare policy is still failing home infusion therapy patients” recently published in The Hill. The article highlights flaws in CMS’ implementation of the Home Infusion Therapy Services benefit that is limiting access to these services.

Carter says, “…almost four years into the creation of a new Medicare benefit designed to promote access to home infusion, this vital health program is failing to keep up with the needs of America’s seniors.”

Unlike all other payers—including commercial plans, Medicare Advantage Plans and others—CMS instituted an unnecessary requirement that a skilled professional be physically present in the patient’s home on the day of administration for Medicare reimbursement to occur.

“This fundamentally defeats the purpose of home infusion, which is to give patients the freedom to receive and administer their infusions at home without a health care professional” says Carter.

This insufficient reimbursement for the extensive services home infusion pharmacies provide jeopardizes Medicare beneficiaries’ access. According to CMS’ own data, less than 1,300 Medicare beneficiaries accessed the benefit each calendar quarter from Q1 2019 to Q1 2021.

“Without access to home infusion, Medicare beneficiaries are instead being directed to institutional settings–increasing costs to both patients and federal taxpayers while unnecessarily inconveniencing patients that don’t otherwise need to be in facilities to receive their care” says Carter.

Legislation before Congress, the Preserving Patient Access to Home Infusion Act (H.R 5067; S.2652) would fix CMS’ failed implementation of the HIT services benefit by providing coverage for infusion services every day a drug is infused, rather than only on days when a skilled professional is physically present.