PHARMACY LEADERSHIP OF INFUSION SERVICES

To encourage healthcare organizations to engage pharmacists and pharmacy leaders in the development and management of infusion service lines; further,

To advocate for payment commensurate with the level and complexity of care and services provided to support sustainable infusion business models; further,

To advocate for the elimination of site of care restrictions to ensure patient preference and continuity of care in infusion services; further,

To encourage use of technology that integrates with patient medical records to enhance medication safety and streamline authorization and adjudication processes.

Rationale

Members of the pharmacy workforce practicing within the infusion business are required to be experts throughout multiple stages of the patient’s treatment including knowledge of the disease states, the management of complex medication regimens, patient education, regulatory requirements, and determination of the appropriate site of care for patients based on clinical needs, policies, and payer requirements. The number of patients receiving home and specialty infusion services has grown rapidly and is projected to continue to grow given the aging population, rates of chronic disease, shift to outpatient services, and increased development of injection-based medications.

Complex payer policies and proposed reimbursement models further complicate infusion therapy. Many patients receiving infusions are shifted to lower cost sites of care, mandated by their health insurers, which may lead to lapses in care, missed infusions, and disconnect from the primary care team. Site neutral payments, prior authorizations, payer denials, and bagging practices all present unique challenges for hospital and health-system pharmacy. Given the high cost, safety considerations, and operational complexity associated with most infusion therapies, health systems have increasingly focused on the oversight and execution of these services. Support is needed to establish sustainable reimbursement models that allow for high-quality, patient-centered infusion services.

The pharmacy workforce has unique knowledge and expertise to navigate most challenges in infusion care, which should be leveraged to provide leadership and oversight for infusion care. This includes the full scope of services encompassing preparation, administration, authorization, and adjudication of care. For example, shifting infusion care to the home setting offers potential cost-savings for health systems and payers, while providing a more convenient option for patients. This shift to home-based care requires care coordination, assessment of home care viability for specific patients, considerations for safety, adherence to regulatory requirements, and around-the-clock access to care. In support of this, pharmacy leaders must identify treatments available for safe and effective administration in the home setting and determine resources required for home-based treatments.

Successful execution of infusion services requires up-to-date technology that fully integrates with health-system electronic medical records. These systems should manage the full breadth of services, from ordering and processing to authorization and adjudication of medication claims. This ensures medications are safely prepared, authorized, and administered in an efficient manner.