Infusion centers are very much affected by legislative action on drugs. An expert offers insights into how best to navigate the situation.
Drugs costs mean infusion centers and the providers who work in them cannot afford to ignore the political landscape. “Even though you may not take an interest in Congress, Congress is definitely taking an interest in you,” said Judith Gorsuch, JD, counsel at Hart Health Strategies Inc. in Washington, DC in a presentation at the 2022 National Infusion Center Annual (NICA) Conference.1 “This is the case because the products you administer tend to be specialty products. They are very expensive in many cases. And so they are a high ticket item for Medicare. And just by that mere fact, these products will always have a target of sorts on them in the eyes of Congress. And by virtue of that, that means that you as the people who administer these products, even though you have zero control over the pricing of them, are going to be sort of caught in the crosshairs of some of these reform proposals.”
Gorsuch laid out the challenges and opportunities for infusion centers that might come out of the near-term political landscape.
“Essentially, the biggest threat to NICA members is anything that causes a sudden drop in Medicare Part B payments,” she said. As to how likely that is to happen, Gorsuch commented that there is a lot of pressure on drug pricing reform for larger political reasons, including both approaching midterms and the larger landscape of budget priorities.
As for political upsides, Gorsuch noted that research shows infusion centers are much more cost-effective options for administering medication that the alternatives. “That is not theoretical. That is the data saying that. And then the last two or three years, more and more research is coming out that office based administration, which is what you're in the eyes of Medicare, is by far the cheapest setting for the program and the safest. Hospital outpatient drug administration, can be more than double the costs of office based administration. And with regard to the home, some data shows that for so many patients, the phone can be cheaper, but not for all. And my sense is that's probably because you lose some economies of scale. Also, we now know the research has some safety implications in that it causes more ER visits within a 24-hour time period after the infusion. And so when you widen the window of cost savings, that may offset some of the savings that you might get from administration. I think in Congress’ mind there is a dogma that the hospital is always the cheapest option, but that is not necessarily true here,” said Gorsuch.
Daley K, Gorsuch J and Nyquist B. Infusion Center Landscape: Policy Threats and Opportunities. Presented at: 2022 National Infusion Center Annual Conference; June 17-18, 2022, New Orleans, Louisiana.