Commercial Payors

NHIA has developed recommendations for commercial, Medicaid and Medicare Advantage payors to reduce administrative burden and remove barriers to accessing certain infusion services.

Designed to be incorporated into contracts between health plans and home and alternate site infusion providers, the recommendations deal with issues such as specialty networks for certain drugs; coordinating the provision of drug, supplies and services; covering preventative services; streamline authorization procedures; and more. Each recommendation includes a detailed rationale and proposed metrics to promote data collection by providers as a means of assessing the success of these proposed policy changes.

By removing barriers to outpatient infusion services, payors can reduce the total cost of care by avoiding hospital stays and emergency room visits, limiting hospital outpatient department use, and preventing admission to long-term care facilities.