IPA is opposed to commercial insurance companies inserting themselves into the patient-physician relationship and interfering with the decisions doctors and patients should be making together. One such example is a recent policy change by HCSC, the parent company of Blue Cross Blue Shield (BCBS) plans operating in Illinois, Montana, New Mexico, Oklahoma, and Texas.
IPA’s Concerns
On April 15, 2025, HCSC began requiring prior authorization before certain drugs can be administered in-office by a healthcare provider. If prior authorization is not granted, the patient must self-inject the drug at home.
IPA believes patients will experience access challenges because of this change. We also fear patients and their providers will be subject to unnecessary friction, administrative burden, and potential safety issues.
Patients with multiple allergies, hives, or severe asthma have an increased risk of suffering allergic reactions when taking several of these medications. In a clinical setting, healthcare providers can respond immediately should a reaction occur. Patients self-injecting at home are put at increased risk, unnecessarily.
Many patients self-injecting at home are less likely to adhere to their treatment plans, so this policy could negatively impact patient outcomes.
Finally, many of these medications must be kept at specific temperatures. IPA members have those capabilities. Patients at home may struggle to store their medication correctly.
IPA is not opposed to patients having the option to self-administer their medication. However, we believe the decision on where and how a patient should receive their treatment should be left up to the patient and their physician, not an insurance company.
Voices in Illinois
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Voices in Montana
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Voices in Oklahoma
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Voices in Texas
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Why is HCSC Really Doing This? Money
When physicians administer these injections, HCSC doesn’t profit. But when patients are forced to inject themselves, the insurer can steer them to Accredo, a specialty pharmacy with financial ties to HCSC – allowing the company to pocket a cut.
While HCSC cashes in, patients are left at risk.
HCSC claims patients can appeal – but the process is a bureaucratic nightmare, designed to wear them down with endless paperwork and phone calls. The result? Many patients will be blocked from the care they need.
This is corporate greed at its worst. And it feeds into a bigger trend within the industry. Today, health insurers deny nearly one in five claims – even though three-quarters of those denials are ultimately overturned on appeal.
About the Infusion Providers Alliance
The Infusion Providers Alliance (IPA) is committed to protecting the integrity of the provider-patient relationship by empowering providers and patients to choose the most appropriate treatment together. We advocate for policies that ensure timely and adequate patient access to high quality care in IPA members’ convenient, community-based, non-hospital settings. IPA members operate over 1,000 in-office or stand-alone ambulatory infusion centers across 43 states nationwide, delivering value to the health care system and improved outcomes to patients.
All inquiries should be emailed to ewarren@infusionprovidersalliance.org.