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Bridging the gap between the hospital and alternate-site care Volume 5 • Number 1 • January/February 2016 • specialtypharmacycontinuum.com
CLINICAL
3 6 8
Engaging patients in TPN home catheter care pays off. Three specialty pharmacy’s plans for ensuring optimal Coagadex outcomes. MHA documents the benefits of its IG treatment program.
POLICY
12 16
Eight key steps for achieving accreditation success.
Medicare bill gains traction
‘Part D’ the culprit
NHIA Predicts Victory For Home Infusion Pay
MAC Prices Hit LTC Sites Hard: Margin Loss Seen
A
fter years of frustration with a Medicare reimbursement scheme that fails to cover their costs, leaders in the field of home infusion are optimistic that they are on the cusp of a major victory. Congress appears poised to pass the Medicare Home Infusion Site of Care Act of 2015 (S. 275/H.R. 605), a bipartisan piece of legislation that, if signed into law, would correct a number of long-standing errors in the way home infusion services are reimbursed. In so doing, S. 275/H.R. 605 would give millions of Medicare beneficiaries access to home care, along with all of the clinical, financial and psychosocial benefits that such care provides, advocates noted.
The benefits of home infusion.
OPERATIONS & MGMT
20 21
What do health plans and employers want?
22
Health systems breaking through the LDN glass ceiling.
Partnership Helps Defray High Cost Of Clinical Testing
C
“We have been working on this legislation since the beginning of this Congress, although it’s legislation that, in this form, has existed over several past Congresses,” said Tyler Wilson, the president and CEO of the National Home Infusion Association (NHIA), in Alexandria, Va. “The thrust of the legislation is to provide coverage for home infusion services, which are not covered by Medicare, despite being covered by many private and commercial insurers.” The key word is services. The majority of home infusion drugs are largely covered under Medicare Part D, Mr. Wilson said. However, the costs of providing services at the home care site are not. These include pharmacy services, such as compounding and preparing infusion drugs, nursing services, supplies and the
ommonly ordered blood tests such as glycated hemoglobin (HbA1C), triglycerides and liver function panels may not come with the same sticker shock as many specialty drugs, but for patients on a tight budget who are paying for these tests themselves, the bill can still add up, especially for chronic conditions requring repeated testing. Now, for the first time, consumers will have help in paying for these tests. In November 2015, a partnership of several leading consumer health organizations announced the launch of Patient Assistance for Lab Services (PALS). In partnership with a national laboratory,
see PAY VICTORY, page 16
see PALS LAUNCH, page 15
DISEASE STATE SPOTLIGHT
See insert after page 12
obert Warnock, PharmD, realized that he had a problem. The senior vice president of pharmacy services for PruittHealth, Dr. Warnock oversees pharmacy services for five long-term care (LTC) pharmacies affiliated with Pruitt, which operates about 100 skilled care nursing facilities in the Southeast. “Things had been going smoothly with our accounts, and we understood what we were billing and being paid,” he recalled in an interview with Specialty Pharmacy Continuum. “But then a year or so ago, we began to notice that our margins were shrinking.” see MAC PRICES, page 18
The push is on for credentialing and privileging of pharmaclsts.
Immune Globulins: Therapeutic, Pharmaceutical, Cost, and Administration Considerations
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FDA Approval Melanoma indication expanded for e Keytruda. See page 11.
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