Imagine a scenario where your aging relative has primary immune deficiency disorder and needs an infused drug to ensure that their immune system fights off infection and other diseases. Now imagine the same scenario where you are told that Medicare significantly slashed reimbursement rates, making it impractical to provide this service at home.
Home infusion therapy is a hallmark of modern health-care delivery that allows patients to receive lifesaving medication in the comfort of home. But if Congress fails to act soon, patients who depend on home infusion therapy — not just those with immune deficiencies, but also those with cancer or advanced heart failure — might soon be without access to the care they desperately need.
The problem stems from an unintended consequence of the 21st Century Cures Act, which was signed into law in 2016 and significantly cut reimbursements for home infusion drugs in 2017 while promising new Medicare home infusion benefits to start in 2021. This gap is leaving many of Wisconsin’s most vulnerable patients without the critical coverage they depend on.
If this issue goes unresolved, it will be increasingly difficult for patients suffering from severe conditions to access home infusion therapy, which is often the most clinically effective and convenient method of treatment for patients managing disorders where their immune system does not properly function. Home infusion therapy is also a lifeline for patients whose illnesses are so severe that they do not respond to oral medication.
The good news is lawmakers on Capitol Hill have a golden opportunity to close this reimbursement gap by incorporating a bipartisan bill in the upcoming resolution to fund the federal government. The legislation — which already passed the House of Representatives — would close the gap in coverage by adjusting the reimbursement benefits for home infusion therapy treatment. The Senate has introduced a companion bill that lawmakers on both sides of the aisle support, but the bill still needs to clear a final vote.
As a leader in negotiating the bill to continue funding the government, House Speaker Paul Ryan should take a stand on this issue to ensure that Wisconsin’s Medicare patients can continue to receive the treatment they need. If a fix is not addressed soon, the Center for Medicare Services has said it will not have time to correct the reimbursement shortfall.
Wisconsin residents suffering from life-threatening immune deficiency disorders, cancer or awaiting heart surgery, along with their family members and loved ones, should not have to fear a government-created gap in reimbursement on top of the many difficult medical decisions they have to make. Medicare patients here and around the country who benefit from home infusion therapy need immediate action from Congress.
Paul Ryan has long been a champion of critical health-care issues, which is why Wisconsin Medicare patients are counting on him to ensure their benefits are protected. He should use his role as the Speaker of the House to close this gap in reimbursement before it is too late.