Many patients with complex health conditions rely on home infusion therapy — medication administered via a needle or catheter — provided in the comfort of their own homes. Home infusion is safe, effective and often less costly than inpatient care, and it plays an invaluable role in helping patients maintain their quality of life.
An unintended consequence of the 21st Century Cures Act, passed by the U.S. Congress and signed into law in December 2016, is creation of a gap in Medicare coverage for certain home infusion services, effectively taking away funding for patient access to high quality home infusion.
The law went into effect January 1, 2017, so it is urgent that we take action now. Please join us in advocating on behalf of vulnerable patients so they can keep their infusion care at home.
What is the 21st Century Cures Act (Cures Act)?
The 21st Century Cures Act was passed by Congress and signed into law in December 2016 with overwhelming bipartisan support. Some of the most publicized parts of the bill include new funding to the National Institutes of Health and the Food and Drug Administration, expedited research and development on debilitating diseases and expedited approval of prescription drugs and medical devices. While the Cures Act will do great good through its major provisions, there are smaller provisions that have unintended negative consequences.
How does the Cures Act affect home infusion?
The 996-page bill includes a provision that changes the payment structure for certain infusion drugs, effective January 1, 2017, under the Medicare Part B Durable Medical Equipment (DME) benefit. The new payment structure (from an Average Whole Price [AWP] metric to an Average Sales Price [ASP] methodology) creates a dramatic reduction in Medicare reimbursement, effectively covering only the drug costs and providing no reimbursement for clinical services to administer the infusion therapy in the home. A separate provision in the law that provides for a clinical services payment does not begin until 2021. This much-delayed services payment start date creates an unsustainable four-year treatment gap for patients who need home infusion therapy for advanced heart failure conditions, blood diseases and heart transplants. This reimbursement funding gap effectively takes away access to high quality home infusion services for some of the most vulnerable patients.
How does the Cures Act affect home infusion patients?
Patients who are already facing difficult health conditions may face a disruption to their care as they transition from hospital to home. Patients who currently rely on home infusion care to sustain their quality of life may lose that access, placing even greater demands on them, their caregivers and family members as they now have to try to find alternate treatment options.
What is the Keep My Infusion Care at Home coalition?
Keep My Infusion Care at Home represents the voice of concerned patients, family members, caregivers, healthcare providers and related organizations. For full list of coalition partners, please visit the coalition page
of Keep My Infusion Care at Home.
What is this coalition working to accomplish?
We are urging legislators to work quickly to establish a fix to this part of the Cures Act, asking them to close the gap between the effective dates of the payment structure change and the addition of a separate clinical services payment. Our primary aim above all else is to ensure that patients have access to high-quality home infusion care to support their health and sustain their quality of life.
How can I become involved in the advocacy efforts?
It will take many different stakeholders – from patients and patient advocacy groups to healthcare providers and hospitals – to drive lawmakers to make the necessary fix and do so quickly. We encourage all stakeholders to take action by writing to urge their respective legislative officials to close the reimbursement gap.
What types of patients will be affected?
The patients most affected by this reimbursement gap are those who receive home infusion therapy for the treatment of severe congestive heart failure, heart transplant and blood diseases.
What are the benefits of home infusion therapy?
Home infusion therapy has several benefits. It is safe, effective, often less costly than inpatient care at hospitals or skilled nursing facilities and it plays an invaluable role in helping patients maintain their quality of life.
What should patients do to find out if they might be affected by the Cures Act?
We encourage all patients to contact their infusion therapy provider to discuss how they may be affected.