Infusions of Specialty Meds
I ‘am looking for opinions on the administration of drugs either in the home or infusion center that are supplied to the patient by a specialty pharmacy. We seem to have a growing number of patients that are bringing in their meds for us to mix & infuse. Is there any liability issues infusing a drug that is not in our control as far as storage? Also, is there any way to get paid for the drug compounding? Submitted By: Jim Lemancik RPh, ThedaCare Infusion, Appleton, WI
Response Summary
There were 3 Listserv responses to Jim’s question:
Mike Hull, Infusion Care - YVMH replied:
We have refused almost all patients that receive their meds via mail order. We have been successful in working with insurance companies to approve drug reimbursement through our facility. We have the benefit of being rural, thus few or no alternatives for the patient. This helps in negotiating with insurances. You're correct in that you are taking on workload and liability and get nothing in return. I could not justify this in our practice.
Dave Grady, Spotted Dog Consulting, LLC, Big Sky IV Care stated:
Many specialty pharmacies provide and bill the drug and in most cases, not much else. They set up their programs to be geared toward MD office infusions, not infusion pharmacy services. We don’t typically take these types of infusion patients because of the shipping/storage issue and potential for liability. Also, this practice further fragments patient care and services and raises the potential for additional problems with the therapy. If you do take on the drug preparation and administration, then you can bill for the per diem (compounding, supplies, pump) and the nursing visit, both up two hours and each hour thereafter. I would certainly charge the insurance and/or patient for your services/supplies. You are providing the most important part of the service, you should get paid for what you do.
Unless of course, the patient can now mix the drug in orange juice.
Jerry Ewancio, P.D., Director of Pharmacy, American HomePatient of Delmarva responded to Jim’s question with:
We have seen this exact situation; mostly the powdered drug has been supplied by a Medicare D supplier with nothing else shipped. In some cases the patients come in daily and pay for us to formulate the med in to the vehicle of their choice, i.e. ReadyMed, Gravity, Cadd pump. They pay as they go! In other situations the patients pay a regular negotiated per diem and we give them "soup to nuts" service.
Rock-Pond Analysis
The dispensing of “High Touch” Specialty Infusion Meds is an evolving daily challenge for many Home Infusion providers. The patients are caught in the middle of all this confusion. They are mailed high cost injectible medications with minimal instruction as to how to administer let alone where to administer them. Our Infusion practices are comprehensive in our service offerings. Patients will continue to pay more out of pocket for services that are not covered.