Will Lawmakers Pass the Infusion Therapy Bill?

When U.S. lawmakers return home in mid-December for the holidays, they will face constituents asking, “What have you achieved in Washington?” Republicans controlling both the Senate and House of Representatives will be especially grilled on healthcare, after failing to repeal and replace the Affordable Care Act.

However, there is one thing lawmakers can do before the holidays that will improve the lives of some of the sickest patients in America — pass a law helping people in line for heart transplants to endure their wait at home rather than in a hospital.

Democrat Mark Warner (Va.), who introduced the bill with Republican Johnny Isakson (Ga.), calls the law a “commonsense fix” for an unintended consequence of another law passed last year. 

Last December, Congress passed the 21st Century Cures Act (CURES,) winning bipartisan support for its laudable goals of promoting medical research and curing cancer. The law unfortunately also cut reimbursement by more than 95 percent for many infusion drugs, cutting monthly Medicare payments from about $11,000 per infusion patient to $500. In its place, it created a new benefit to reimburse home-infusion providers, but that provision does not take effect until 2021. That funding gap is hurting patients, but Warner-Isakson would bring the new benefit forward to the start of 2019.

This is not a budgetary issue: The Congressional Budget Office says home infusion is the most cost-effective way to treat patients. Private insurance, Medicaid, Tricare (for veterans) and Medicare Advantage, all still pay for home infusion, but it is not covered by traditional Medicare after the passage of CURES.

While this legislation is small in the general scheme of things, it’s a big deal to the patients that it impacts. About 4,000 patients in the United States are waiting for a heart transplant at any time, a wait that can last up to one year or more. They would typically receive their drugs via home infusion therapy, but now many Medicare patients have to endure their wait from a hospital, which costs significantly more and leaves them with a diminished quality of life.

Making matters worse, some of these patients are considered too sick and prone to infection to endure a long wait in a hospital, so they are undergoing invasive surgery to implant a left ventricular assist device, or LVAD — implantation of a mechanical pump inside the patient’s chest to help their weakened heart to pump blood. That expensive surgery could be avoided for many patients if they could receive home infusion while waiting for their transplant.

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