Congress recently averted a healthcare crisis by working in a bipartisan fashion to fix a problematic Medicare policy that would have left many of Connecticut’s most vulnerable Medicare beneficiaries without access to lifesaving treatment. Lawmakers should build on this bipartisanship and ensure Medicare provides a comprehensive home infusion benefit for beneficiaries here and around the country.
As part of a sprawling spending deal passed earlier this month, Congress addressed an unintended gap in Medicare coverage created by the 21st Century Cures Act of 2016 that would have blocked access to vital home infusion therapy treatments for thousands of Medicare policyholders until 2021. These treatments, which involve the administration of medication through a needle or catheter, are essential to patients whose illnesses are so severe that they cannot respond to oral medication alone.
Fortunately, the potential disaster was avoided thanks to the leadership of U.S. Rep. John Larson and others who recognized the importance of addressing this dangerous Medicare issue before it was too late. Lawmakers closed the looming coverage gap and now Medicare will cover the cost of specific infusion medications as well as the clinical services required to administer the treatment at the patient’s home. I thank and commend Congressman Larson for his role in shepherding this fix through the legislative process.
This is good news for the thousands of Medicare patients who rely on home infusion therapy, and for the Medicare program itself, which could save millions of dollars over the next decade because this treatment allows patients to avoid expensive hospital visits. But Medicare home infusion patients need Congress to act again to make certain that the coverage that is now in place for certain home infusion drugs is extended to home infusion drugs that are in Medicare’s prescription drug program.
Currently, Medicare covers a majority of infusion drugs, but does not always cover the clinical services and medical devices required to effectively administer many of these medications that are in Medicare’s prescription drug program. As a result, Medicare beneficiaries are effectively denied access to certain home infusion therapies and are being forced into hospitals or nursing facilities at a significantly higher cost to the program.
To address this issue, Congress should reintroduce and pass the Medicare Home Infusion Site of Care Act. This bipartisan legislation would build upon the recently passed legislation and create a comprehensive benefit for all home infusion drugs, as well as the necessary supplies, equipment and services associated with treatment. Not only would this common sense solution expand access to home infusion treatment to some of Medicare’s most vulnerable patients, it would also accelerate Medicare’s future cost savings and improve its long-term sustainability.
The recent bipartisan effort demonstrated Congress’s commitment to address Medicare’s fragmented reimbursement system and provide patients with ongoing access to affordable home infusion treatment. Connecticut’s Congressional delegation can build on this victory by supporting these necessary reforms to ensure patients have the lifesaving treatment they desperately need.
Tyler J. Wilson is President of the National Home Infusion Association, which represents the companies that provide infusion therapy to home-based patients as well as companies that manufacture and supply infusion and specialty pharmacy products.