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Covid-19 Reignites Push to Make IV Drugs Easier to Get at Home

April 28, 2020, 9:51 AM

Home health agencies and lawmakers are calling for a policy change to certain Medicare benefits to let more patients who need lifesaving IV drugs get those medications at home during the coronavirus outbreak.

Enabling more at-home drug infusions would protect people at high risk for severe complications, such as the elderly or immuno-compromised, and help hospitals around the country clear space for Covid-19 patients.

But while the federal Medicare agency has relaxed a host of other regulations to make it easier for doctors and nurses to combat the pandemic, it hasn’t taken action to make it easy enough for patients to get at-home infusions, home health agencies and attorneys say. An important step would be tweaking rules allowing more drugs to be infused at home and expanding when companies can bill for those services, they say.

“They haven’t applied that same flexibility and expansive authority to home infusion yet. But when there’s a regulatory will, there’s a way,” David Farber, a health regulatory attorney at King & Spalding LLP who represented the National Home Infusion Association in a lawsuit over payment issues, said.

The NHIA and home health agencies want the Centers for Medicare & Medicaid Services to expand coverage for more lifesaving intravenous drugs to be administered at home.

Coverage in Debate

In the past month, more than 200 lawmakers and 100 health organizations and businesses signed letters supporting expanded Medicare home infusion benefits to protect seniors from the new coronavirus. Those types of treatments are usually done in hospitals or doctors’ offices.

Getting Medicare to pay enough for the services as well as the drugs is the crux of the debate over home infused drugs. Medicare Part B, which typically covers drugs administered in a doctor’s office, pays for services for about 30 drugs to be administered at home that use a specific type of medical equipment.

Drugs covered by Medicare’s outpatient drug network—known as Part D—don’t have a home infusion benefit, “which severely limits Medicare beneficiary access to these home infusion drugs,” nine health care systems told CMS Administrator Seema Verma earlier this month.

Doctors can bill for more services they supervise virtually due to a CMS policy change the agency implemented during the pandemic, an agency spokesman said. Before that, a doctor had to be physically present in a patient’s home to bill for a service.

However, more needs to be done to make home infusions of medications more accessible, medical providers said.

‘A Simple Interpretation Fix’

Home infusion benefits for Medicare were created in 2016 through the 21st Century Cures Act. Although Medicare pays for the actual drugs a patient uses, it might not pay for the services required to administer them at home.

The groups are asking for an emergency waiver during the Covid-19 emergency to expand the definition of a home infused drug and when companies are paid to administer them.

The CMS could reinterpret when home infused drug services should be paid for in its Part B benefit, Connie Sullivan, president and CEO of the National Home Infusion Association, said. The way the billing system is set up now, pharmacies have to send their own nurses to administer the drugs to get paid, even if one is already at the patient’s home, she said.

That isn’t good during an emergency like Covid-19 because patients are encouraged to have as little contact with people as possible. Restructuring payments so the nurse who is already there could administer the drug would be more effective, Sullivan said.

“That’s a simple interpretation fix,” Sullivan said. She said she’s not sure if more expansive changes, like reinterpreting home drug treatment benefits in Part D, would require Congress to step in.

Lawmakers like Reps. Eliot Engel (D-N.Y.) and Fred Upton (R-Mich.) and Sens. John Cornyn (R-Texas) and Debbie Stabenow (D-Mich.) have also asked regulators for more flexibility.

“CMS oftentimes takes a very narrow view of its mandate and is very cautious in expanding into new areas,” Farber said. “In a Covid scenario it’s a completely different world because now we suddenly have major drivers to keep patients at home and to keep everyone home you have to have access to these drugs that have to be infused.”

Under those circumstances “the calculus changes,” he said.

To contact the reporter on this story: Jacquie Lee in Washington at jlee1@bloomberglaw.com

To contact the editors responsible for this story: Fawn Johnson at fjohnson@bloomberglaw.com; Andrew Childers at achilders@bloomberglaw.com

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