Serving managed care, health system and specialty decision makers Volume 10 • Number 3 • May/June 2021 • specialtypharmacycontinuum.com
TECHNOLOGY Flexibility, telepharmacy keep PAPs on track during COVID-19 ................
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CLINICAL 7 habits of effective COVID-19 treatment managers ...............................
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Propylene glycol-free melphalan passes safety test .............................
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POLICY Raising the SBAR for safer cleanrooms during a pandemic ........
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Strategies for boosting biosimilar uptake .............
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OPERATIONS & MGMT Coalition slams mandatory white bagging—and payors fight back ..........................
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REVIEW ARTICLE
Management of
Chronic Obstructive Pulmonary Disease See page 8.
Providers urge feds to prioritize home-based care
Mitigating risk:
A Rollercoaster Year For Home Infusion Rx J
Opioid-Benzo Combination Eyed by Payors
W
ust over one year ago, like so many other businesses across the country, Upstate HomeCare went from normal operations to sequestered virtually overnight as the COVID-19 pandemic hit the United States. Senior Vice President and CEO Greg LoPresti sent approximately 40% of the staff of his Clinton, N.Y. home health care service agency, which serves the Albany, Syracuse, Rochester and Buffalo regions, to work from home. Meanwhile, the staff who had to work in person— including drivers, nurses and pharmacists—needed to readjust their care models. “Many of the core services we provided, like postsurgical home infusions, dried up overnight,” Mr. LoPresti said. “Meanwhile, we had more specialty and chronic care cases for patients with conditions like primary immunodeficiency and CIDP [chronic inflammatory demyelinating polyneuropathy]. The neurology practices were all open, and while they tried to minimize routine patient care to minimize exposure, patients with these severe chronic conditions had to be seen. Patients who would have gone to more traditional outpatient infusion facilities to get care came to us in droves.” Upstate HomeCare also was in the middle of a pilot study, in partnership with pediatric gastroenterologists at Golisano Children’s Hospital at the University of Rochester Medical Center, to assess the safety and effectiveness of home infusion of anti–tumor necrosis factor therapies for pediatric patients with chronic conditions such as Crohn’s disease and ulcerative colitis. “This is standard for us, but with a pediatric population, there had been concern about doing these infusions in the home, especially for the
ith the concurrent use of benzodiazepines and opioids involved in approximately 16% of fatal overdoses, according to the CDC, management of the medications represents a significant challenge for payors. Benzodiazepines are FDA-labeled for conditions such as seizures, insomnia, generalized anxiety disorder and panic disorder, and usually are intended for short term—weeks to months, said Kimberly Lenz, PharmD, the director of clinical and operational pharmacy for MassHealth, the Massachusetts Medicaid program, at the University
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Special Focus:
Sterile Compounding See pages 14–16
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Home Infusion Audits, Low Pay: Action Needed
H
ome infusion pharmacy clinicians can make the most of reimbursement opportunities and minimize risk in payor audits with basic understanding of key reimbursement concepts, including pricing, contracting, prior authorizations (PAs), and billing for waste, experts reported at the 2021 virtual annual meeting of the National Home Infusion Association (NHIA). “Resist the temptation to dismiss these topics by thinking ‘we have a revenue cycle team that handles all that,’” said Ryan Garst, PharmD, MBA, the NHIA’s senior director of clinical services.
