Do government and private insurance plans cover infusion therapy in the home and other alternate-sites?
The range of variables that must be managed by the infusion pharmacy to ensure safe and appropriate administration has led nearly all commercial health plans to treat home infusion therapy as a medical service, reimbursed under their medical benefit (rather than the prescription drug benefit) and paid for using a per diem for clinical services, supplies, and equipment with separate payments for the drugs and nursing visits. It also has led most commercial plans to require that infusion pharmacies be accredited by nationally recognized accreditation organizations. Commercial plans have used this model aggressively to reduce overall health care costs while achieving high levels of patient satisfaction. Government health plans such as Medicaid, TRICARE, and the Federal Employees Health Benefits Program also reimburse for home infusion therapy, although for Medicaid in a few states the extent of coverage can have gaps. A major exception in completeness of coverage is, unfortunately, the Me
