S. 1058: Preserving Patient Access to Home Infusion Act

This bill, titled the Preserving Patient Access to Home Infusion Act, aims to amend certain sections of the Social Security Act related to home infusion therapy under the Medicare program to ensure that patients have continued access to these services. Key provisions of the bill include:

Inclusion of Pharmacy Services

The bill specifies that home infusion therapy can include pharmacy services in addition to existing nursing services. This means that when patients receive home infusion therapy, they will also have access to medication preparation and coordination services. It enhances the definition of what is covered under home infusion therapy.

Payment Adjustments

The legislation revises the payment structure for home infusion therapy. Key aspects include:

• The payment for home infusion therapy will account for each day an infusion drug is administered, regardless of whether a qualified supplier is physically present.
• A transitional payment rule will apply for services provided between January 1, 2026, and January 1, 2030, ensuring that payments reflect at least five hours of infusion therapy per day.
• If a supplier is not present during the administration of the infusion, the payment will be reduced to 50% of what would have been paid if the supplier were there.

Role of Nurse Practitioners and Physician Assistants

The bill expands the scope of who can establish and review a home infusion plan of care. Nurse practitioners and physician assistants are now included alongside physicians, allowing them to also manage patient care related to home infusion therapy.

Access to Non-Pump Drugs and Biologicals

The definition of what qualifies as a home infusion drug is modified to include certain non-pump drugs and biologicals. The bill clarifies that drugs administered intravenously that do not require a pump can still be covered under home infusion therapy.

Billing Clarifications

It clarifies billing for specified non-pump drugs and biologicals, ensuring that payments can still be made for services related to these drugs, even if those drugs are not individually covered under the Medicare program.

Special Payment Rules for Supplies

The bill introduces a special rule regarding payments for items and supplies provided with home infusion therapy, emphasizing cost containment. Payments will not be made for specific items and services furnished on the same day as home infusion therapy if payment has already been made for the infusion.

Effective Date

The amendments introduced by this bill will take effect for services provided on or after January 1, 2026.

Relevant Companies

• ABBV - AbbVie Inc. may be impacted as a provider of various infusion therapies that are covered under Medicare.
• AMGN - Amgen Inc. could see changes in its home infusion product offerings and related reimbursements.
• BMY - Bristol Myers Squibb could have some impact due to its portfolio of drugs that may be used in home infusion therapy.