Home Infusion Pharmacies Opt Out of Medicare Drug Benefit

Many California home infusion pharmacies, which provide intravenous drugs to patients in their homes, are declining to participate in Medicare Part D because they say reimbursement rates do not cover their costs and administrative requirements are cumbersome, the Sacramento Bee reports.

According to Barbara Biglieri, director of policy for the California Association for Health Services at Home, about 200 of the state's 5,000 pharmacies are licensed to provide home infusion therapy.

However, the Medicare drug benefit covers the cost of medication only, and does not pay for equipment, supplies or staff needed to mix and administer the drugs, Ramona Moenter, general manager of Chartwell Home Therapies, said.

Eileen Goodis, president of Home Pharmacy of California, said the trade association is asking CMS to cover home infusions under Medicare Part B, which pays for doctor visits and outpatient services.

Stan Rosenstein, deputy director of medical care services for the Department of Health Services, said there has been no drop in coverage of infusion supplies for people dually eligible for Medi-Cal and Medicare benefits. Rosenstein said that Medi-Cal paid for such supplies before the Medicare drug benefit took effect and will continue to cover such costs for dual eligibles, but he added that the claims process under the Medicare drug benefit might be "segmented more" for infusion providers (Weaver Teichert, Sacramento Bee, 2/8).

The Fresno Bee on Wednesday examined the "many independent pharmacists whose revenues are being pinched" under the Medicare drug benefit as they "are still waiting to be reimbursed for hundreds of prescriptions." Other pharmacists "are being paid less by Medicare's new private drug plans," the Fresno Bee reports.

"Hardest hit" are smaller, independent pharmacies with a large number of dually eligible customers, according to the Fresno Bee.

According to John Cronin, senior vice president and general counsel of the California Pharmacists Association, some pharmacies have limited finances or do not have the ability to recoup losses with other sales (Rodriguez, Fresno Bee, 2/8).

California "can't escape its responsibility to provide medical care for a vulnerable population," but states "should not have to pay for the flaws of the federal Medicare drug program," a Sacramento Bee editorial states. The editorial continues, "That responsibility falls to the [Bush] administration and to Congress," and "[t]hey should get to it" (Sacramento Bee, 2/8).

Additional information on the Medicare drug benefit is available online.