Congress passed the new home infusion
The Innovatix Government Affairs
become an eligible provider. Nonetheless,
law as part of the Bipartisan Budget Act of
team worked tirelessly to keep home
this new law is a major development
2018, addressing a damaging unintended,
infusion top of mind in Washington
for those providing infusion therapies.
consequence of a previous law, the 21st
and to help get this legislation across
Importantly, the law defines an eligible
Century Cures Act (Cures Act), which was
the finish line. We created the Innovatix
provider as “a supplier that is enrolled
signed into law during the holidays in
Campaign for Home Infusion Payment
under this part as a pharmacy that
2016. While this “21st Century Christmas
Relief, which encompassed more than 150
provides external infusion pumps and
Tree Act” was aptly dubbed, both for its
meetings on Capitol Hill with staff from
external infusion pump supplies and
timing and for the fact that it contained
key health policy committees, leadership,
that maintains all pharmacy licensure
attractive provisions for many different
and other key Congressional offices.
requirements in the State in which the
interests,1 it nobly paved the way for
We developed a membership survey to
applicable infusion drugs are admin-
new and important funding to accelerate
help Congress better assess the harmful
istered.” It will establish a payment for
scientific advancements and treatment
consequences of the law for providers
professional services, including nursing,
for patients in need. Unfortunately, albeit
and beneficiaries. We also sent in and
training and education (not otherwise
inadvertently, the Cures Act contained
signed on to numerous stakeholder
paid for as durable medical equipment),
two problematic provisions for the home
letters and placed multiple calls, both
and monitoring of home infusion therapy
infusion industry.
independently and with our members.
and related drugs furnished by a qual-
The Cures Act largely reduced
We appreciate our members and
payments for infusion drugs under the
partners joining in this effort to pass this
Medicare Part B durable medical equip-
legislation. Innovatix members across the
ment (DME) benefit from an average
country weighed in with their elected offi-
wholesale price (AWP) to an average
cials. Constituent outreach played a major
sales price (ASP) payment methodology
role in demonstrating the damaging impact
Furthermore, the fact that infusion
as of January 1, 2017. The law included
of the law on a local level. And, of course,
services have received recognition in
a long-sought-after policy to create a
this was an effort made possible with
Medicare Part B will serve as a gateway
Medicare payment for the professional
bicameral, tri-committee (House Ways &
for obtaining coverage for services in
services associated with home infusion
Means, House Energy & Commerce and
Medicare Part D. Some imminent chal-
therapy for Part B DME infusion drugs
Senate Finance) and bipartisan support.
lenges are to be expected in passing new
(which would not have started until
Both Republicans and Democrats recog-
infusion legislation. Congress only has a
January 1, 2021), resulting in a lengthy
nized that patient access issues related to
limited number of days left to meet and
and inappropriate four-year gap in
home infusion transcended party lines.
work in 2018, with holidays and midterm
2
Innovatix In Action
Congress has finally recognized the need to compensate providers for the valuable home infusion services they furnish beyond the ingredient cost of a drug.
elections coming up. The current
the implementation dates of the two policies.
ified home infusion therapy supplier.3
Opportunities for Home Infusion The transitional reimbursement for
Congress will adjourn at the end of 2018, and all unresolved legislation will need to be reintroduced starting in January, with the process starting anew.
The road to addressing this
home infusion clinical services delivered
dangerous “care gap” was neither
under Medicare Part B that became
short nor straightforward given the
Despite these challenges, Innovatix
law as part of the Bipartisan Budget
competing priorities of Congress and
and the industry have built solid
Act of 2018 addresses a dire gap in the
the Administration. Not unique to this
support for infusion in Congress.
reimbursement for clinical services due
Congress and Administration, though
Obtaining coverage for infusion
to the Cures Act. Providers now have
seemingly more precarious, Republicans
services under Medicare Part D
certainty and can better plan knowing
and Democrats have struggled to find
remains an exciting opportunity, and
that relief is on the way starting in 2019.
common ground on large, far-reaching
the industry is the closest it has ever
(A permanent reimbursement structure
policy issues, such as stabilizing the
been to achieving this policy goal. Part
is expected in 2021.)
D services legislation would greatly
Affordable Care Act health insurance marketplaces, tax reform, and immigration, to name a few. Even so, Innovatix pressed forward, demanding change for thousands of infusion providers and thousands of beneficiaries.
The Centers for Medicare & Medicaid Services (CMS) will now start working to implement the new law. To do this, the
change the scope of coverage for infusion providers and the vulnerable beneficiaries they serve.
agency will need to resolve issues, such as
Be sure to check out other Innovatix
billing specifications and requirements to
policy accomplishments that follow. Innovatix | innovatix.com 13