The most recent home infusion therapy (HIT) monitoring report from the Centers for Medicare & Medicaid Services (CMS) shows declines in the number of providers who participated and the number of Medicare beneficiaries who used home infusion therapy services.
The February 2024 report includes data through the second quarter of 2023, which was compared to data going back to 2021.
“Only 203 suppliers have participated in the benefit out of nearly 1,500 eligible infusion pharmacies and thousands of home health agencies,” the National Home Infusion Association (NHIA) said in a March 19 announcement. “Most providers have made only a handful of visits, with just seven accounting for more than half (55%) of all HIT visits. This lack of participation leaves many states with no participating providers for Part B HIT services.”
Overall, falling home infusion usage
In the executive summary of the February 2024 report, CMS acknowledged that Medicare beneficiary use of home infusion therapy — described by CMS as involving “the intravenous or subcutaneous administration of drugs or biologicals to an individual at home” — was falling. HIT comprises three categories of administered drugs, according to the CMS report:
Category 1 for certain intravenous infusion drugs for therapy, prophylaxis, or diagnosis, including antifungals and antivirals; inotropic and pulmonary hypertension drugs; pain management drugs; and chelation drugs. Category 1 accounts for the largest percentage of HIT visits.
Category 2 for subcutaneous infusions for therapy or prophylaxis, including certain subcutaneous immunotherapy infusions.
Category 3 for chemotherapy drugs or other highly complex infusion drugs or biologicals.
“From Q1 2021 to Q2 2023, the quarterly average of HIT service visits was about 7,500 visits,” the report said. “HIT service visits increased in 2021, decreased slightly in 2022, and continued to decrease in the first half of 2023.”
While the number of HIT drug recipients using category 2 drugs rose slightly from Q1 2021 (8,059 recipients) to Q2 2023 (8,351 recipients), the report said, “Category 1 and category 3 HIT drug recipients have slowly decreased since Q2 2021.”
Legislative efforts aim to ‘fix’ Medicare’s home infusion benefit
“Without a per infusion day payment for pharmacy services, access will continue to wane,” NHIA said in its statement. “Medicare beneficiaries deserve the same site of care options as commercial insurance patients — which is why NHIA is advocating for the passage of the Preserving Patient Access to Home Infusion Act.”
That act — H.R. 4104, S. 1976 — “permanently fixes” the home infusion therapy services benefit, NHIA said.
“Despite legislative efforts to establish comprehensive coverage for home infusion therapy, barriers persist that prevent many Medicare beneficiaries from accessing these vital services,” NHIA said. “The current interpretation by CMS limits reimbursement to days when nurses are physically present in the patient’s home, disregarding essential services provided remotely by home infusion providers. This restrictive policy undermines patient care and exacerbates health-care costs by forcing unnecessary hospital admissions and readmissions.
“By supporting the Preserving Patient Access to Home Infusion Act, we can enhance access to home infusion services for millions of Medicare beneficiaries nationwide.”