The Infusion Providers Alliance (IPA) is the leading voice for in-office and freestanding ambulatory infusion care, representing over 1,000 community-based, non-hospital providers across the United States. Our members are committed to preserving the integrity of the provider-patient relationship in a manner that delivers exceptional care to patients and value to the health care system. Our facilities are major access points of care for patients with complex and chronic health conditions, including a host of auto-immune conditions such as rheumatoid arthritis, Crohn’s disease, ulcerative colitis as well as many other rare diseases. The convenience and exceptional patient experience in our facilities keeps these patients adherent to their medications and reduces flare ups and emergency hospital admissions.
The IPA wants to be part of the solution in reducing Medicare beneficiaries’ pharmaceutical costs, and to that end supports the following policies:
- Encouraging the migration of Part B drug administration to the most efficient setting of care;
- Tiered add-on payments, to encourage the selection of less expensive drugs when appropriate;
- A cap on beneficiary out-of-pocket expenses for Part B drugs and the ability for pharmaceutical manufacturers to provide cost-sharing assistance for these drugs; and
- Increase biosimilar adoption to fuel competition.
Encourage Migration of Part B Drugs to More Efficient Setting
Medicare pays physician offices and freestanding infusion centers approximately half as much as hospitals for administering Part B drugs. For example, IPA infusion centers and practices regularly bill CPT code 96413 for the first hour of infusions of complex drugs such as Remicade, Ocrevus, and Entyvio for patients with a variety of diseases including Crohn’s disease, Multiple Sclerosis, and ulcerative colitis; for this particular CPT code, we are paid approximately 45 percent of the hospital rate: $309.56 vs $142.55. The contrast is even greater for CPT code 96372 for therapeutic, prophylactic or diagnostic injections such as for administering Boniva, Xolair, and Prolia for osteoporosis and arthritis: $60.46 in the hospital versus just $14.44 in the physician’s office, or 25 percent of the hospital cost.