Cancer Therapy Advisor: Medicare Limits Cancer Patients’ Access to Home Infusions. A New Bill Could Change That.

From Cancer Therapy Advisor: Home infusion of cancer treatments has gained traction in some pockets of the United States over the last few years, but reimbursement and benefit design within fee-for-service Medicare are creating barriers to greater use, according to proponents of cancer care at home. Penn Medicine, which launched its Cancer Care @ Home program in 2019, administers about 5% to 10% of all cancer infusions or injections in patients’ homes. However, that number could go as high as 20% while maintaining safety and effectiveness, according to Justin E. Bekelman, MD, an oncologist and director of the Penn Center for Cancer Care Innovation in Philadelphia. Dr Bekelman explained that one of the barriers to expanding the Penn program, and to uptake of home infusion by other providers, is that Medicare covers most at-home cancer treatments through the Part D drug benefit.¹ This leaves patients with significantly higher out-of-pocket costs than if they received treatment in an ambulatory or hospital setting, which is covered under Part B. “It’s not purposeful. It’s just a switch between government benefit design programs,” Dr Bekelman said. “We need creative solutions such that home cancer care and programs like it that are so patient-centric are not inadvertently disincentivized by reimbursement or benefit design issues.” Medicare Home Infusion Benefit Private insurers in the under-65 age market have embraced coverage of home infusions, but fee-for-service Medicare coverage is limited, said Connie Sullivan, BSPharm, president and CEO of the National Home Infusion Association (NHIA) in Alexandria, Virginia. “For the most part, you don’t have the option to just choose home [care], even if it’s what works best for you because Medicare does not have a comprehensive benefit around your catheter supplies, the pump that’s needed, administration supplies, tubing, flush syringes, and then all the work that happens at the pharmacy to acquire the drug, prepare the drug, and coordinate with everybody who has to be involved,” Sullivan said. “It’s a benefit in name only.” Although most cancer drugs administered at home are covered under the Part D drug benefit, the 21st Century Cures Act created a Medicare home infusion therapy benefit that covers the professional services for certain drugs and biologics administered either intravenously or subcutaneously through a pump. The benefit, which went into effect in January 2021, covers nursing services, training and education, remote monitoring, and other monitoring provided by a qualified home infusion therapy supplier. Overall, the benefit covers 34 drugs for home infusion, including 8 chemotherapy drugs. The most commonly provided chemotherapy treatment under the benefit is fluorouracil. Read more at Cancer Therapy Advisor.