Examining Lack Of Medicare Coverage For Home-Infusion Therapy

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The Wall Street Journal on Wednesday examined how a growing number of people "needing intravenous medications are getting their treatment at home. But a gap in Medicare coverage is making it harder for older and sicker patients to swap hospital stays for home care." According to the Journal, many private insurers provide full coverage for home-infusion therapy. Administering the medications at home typically costs $150 to $200 daily, compared with $1,500 to $2,500 per day for a typical inpatient hospital stay. Home-infusion therapy also reduces patients' risks for contracting an infection through IV lines and catheters at hospitals.


Medicare covers the cost of medications administered intravenously through its prescription drug benefit plan -- "not the pharmacy and nursing services, supplies and equipment that make up roughly half the cost of home-infusion therapy," the Journal reports. Some beneficiaries with supplemental Medicare coverage can receive infusions at outpatient facilities, but most have to be admitted to a hospital or nursing home, where services are covered under Medicare Part A.

Russell Bodoff, president of the National Home Infusion Association, said, "The situation is inconvenient and difficult for elderly Medicare patients, particularly the infirm with reduced immune systems or those who live in rural areas." According to a study commissioned by the association, legislation being considered in Congress that would provide home-infusion coverage under Medicare Part B would cost $1.5 billion over 10 years and would save the program an estimated $7.4 billion during that time if 10% of patients who usually receive intravenous medications in a hospital switch to home-infusion (Landro, Wall Street Journal, 10/15).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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