Alexandria, VA — November 6, 2025 — The National Home Infusion Association (NHIA) today held its annual Advocacy in Action Day, during which association members and patients met with Members of Congress and their staff to advocate for a fix to the Medicare home infusion coverage gap. Over the course of the event, NHIA members held more than 130 meetings in support of the Preserving Patient Access to Home Infusion Act (H.R. 2172 / S. 1058).
NHIA members representing provider and supplier companies, along with patients who depend on home infusion services, participated in the event to share their experiences and discuss the critical need to modernize Medicare coverage for home infusion therapy.
“Home-based infusion is a proven, patient-preferred model that delivers safe, effective care while lowering costs and relieving pressure on hospitals and skilled facilities,” said Connie Sullivan, BSPharm, President & CEO of NHIA. “We’re grateful to our bipartisan champions—Reps. Vern Buchanan (R-FL), Debbie Dingell (D-MI), Diana Harshbarger (R-TN), Terri Sewell (D-AL) and Sens. Tim Scott (R-SC) and Mark Warner (D-VA)—for leading on this critical issue. NHIA will continue to fight for seniors who need timely access to home infusion services. It’s time for Medicare to evolve and catch up to the private sector, where patients can receive care in their preferred setting—the home—while reducing total health care costs.”
Why Action Is Needed
Medicare’s current home infusion therapy (HIT) services benefit is limited to approximately 36 drugs that utilize infusion pumps for administration and does not provide adequate coverage for the pharmacy professional services that make home infusion possible. As a result, few home infusion pharmacies participate in the benefit, limiting access for seniors and individuals with disabilities. This contrasts with commercial insurance payors who make home infusion readily available for over 300 unique drugs and biologics, including IV anti-infectives, which are among the most routinely used home therapies.
Each year, an estimated one million Medicare patients are diverted to outpatient departments or skilled nursing facilities to receive IV anti-infective therapies because of the existing coverage limitations. This not only increases overall health care costs but also restricts patient choice and access to timely, clinically appropriate care at home.
The Legislative Solution
The Preserving Patient Access to Home Infusion Act would modernize Medicare’s home infusion therapy benefit by closing existing coverage gaps and recognizing pharmacy professional services essential to the safe delivery of care in the home as well as expanding care for Medicare beneficiaries who require IV anti-infective treatments. By aligning Medicare policy with the commercial insurance model, the legislation would ensure patients have access to home infusion services when clinically appropriate and reduce overall health care costs by allowing more patients to receive therapy in the most appropriate and cost-effective setting.
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NHIA is a trade association representing companies that provide infusion therapy to patients in their homes and companies that manufacture and supply infusion-related products and services. Infusion therapy involves supplying and administering patient-specific sterile medications, and coordinating a range of pharmacy, nursing, and other clinical services for delivering care to patients in the home setting. For more information, visit www.nhia.org.
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.
