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February 2, 2022
CMS recently issued a report which summarizes utilization trends for the Medicare Part B home infusion therapy (HIT) services benefit over the past 3 years. The data is consistent with independent findings from an NHIA internal analysis that the benefit – as currently implemented – has failed to draw sufficient participation from providers to ensure equitable access to beneficiaries across the U.S.
The report found a decrease in provider participation in the benefit. Between Q1 of 2019 and 2021, the number of participating DME/HIT supplier organizations fell 25% from 54 to 40 (top graph). This despite there being nearly 1,000 DMEPOS pharmacies, 11,000 home health agencies, and a wide range of other providers in the U.S. capable of participating in the benefit
In addition, the report notes a drop in beneficiary utilization coinciding with the COVID-19 public health emergency. This finding runs counter to commercial claims obtained by NHIA from 2020 and 2021 that indicate the PHE has prompted an overall increase in home infusion utilization.
“Considering this summary, NHIA urges CMS to expeditiously reconsider the definition of infusion calendar day, as well as expand the definition of professional services to include those offered by pharmacists. By not accounting for the full range of services, patients are losing access to home-based IV care at a time when these services are most needed,” said Connie Sullivan, BSPharm, NHIA President and CEO.
NHIA sent a letter to HHS requesting that the agency make permanent Medicare payment for COVID-19 monoclonal antibodies (mABs).
On April 19, 2022, Baxter announced a supply disruption of the ExactaMix valve sets (ExactaMix 1200 Valve Set H938792 and ExactaMix 2400 Valve Set H938724) due to raw material constraints that are impacting production volumes. As a result, healthcare providers and institutions are driven to consider conservation measures when compounding using the ExactaMix Automated Compounder.
NHIA submitted comments on California SB 958, the Medication and Patient Safety Act of 2022, supporting amendments to the proposed legislation that allow for infused medications to be administered in the enrollee’s home when the physician and patient determine it is in the patient’s best interest and weighing in on various other aspects of the bill.
