Infusion Providers Alliance
The Infusion Providers Alliance is the leading voice for in-office and freestanding ambulatory facility providers of drug infusion services. Alliance members are committed to preserving the integrity of the provider-patient relationship in a manner that delivers exceptional care to patients at a value to the health care system.
Our members have facilities located in communities across the nation, each of which offers a more convenient, more efficient and less expensive alternative for patients than receiving their infusions in the hospital setting. These facilities serve as critical access points of care for patients and save tremendous dollars for commercial and government payers alike while also lowering out of pocket costs for beneficiaries.
The Infusion Providers Alliance mission is to serve as a thought leader and to educate on issues critical to safeguarding, supporting, and strengthening provider directed, patient-focused access to in-office and freestanding ambulatory facility infusion services.
Insurer Specialty Pharmacy Mandates Increase Costs and Will Have An Adverse Impact on Patients
Recently, some insurance companies have instituted polices requiring biologic infused or injectable drugs to be procured exclusively through a specialty pharmacy. These changes undermine the provider-patient relationship and shift these sensitive prescribing decisions from the provider to an insurance company. They will also lead to increased costs in the overall health care system. The proliferation of specialty pharmacy requirements will further place a significant burden on providers to manage inventory from numerous pharmacies for numerous patients.
A specialty pharmacy mandate could put patients’ health at risk
When insurance companies empower specialty pharmacy to control the distribution and prescribing of infused medicines, patients’ health can be put at risk. Receiving the right medication at the right time is imperative for treatment of chronic disease. Yet specialty pharmacies often do not provide the appropriate inventory to providers, harming their ability to provide the proper medication if a patient misses an appointment or if their prescribed dosage changes. Such a system only results in unnecessary wastage as medications cannot be reused, requiring the infusion center or provider office to procure a new drug, which can result in lapses in treatment. Delays in treatment cause serious health implications for patients.
In some cases, these new rules mandate infusion drugs be administered solely as self-injectable drugs without regard to whether a provider prescribes it as a health care provider (HCP) administered drug. Certain patients need health care practitioner clinical oversight for potential adverse reactions and proper administration of the product. Failure to provide the option of health care practitioner administration may decrease adherence and can also cause gaps in treatment. This would especially impact patients with a fear of needles and patients facing difficulty in using the self-injectable. The Diagnostic and Statistical Manual of Mental Disorders recognized this phobia as affecting nearly 50 million Americans and that roughly 20% of these individuals avoid medical treatment as a result. (1)
A specialty pharmacy mandate is wrong approach to cut costs
Some insurance plans insert specialty pharmacy via “white bagging,” or distribution of patient-specific medication from a specialty pharmacy to the provider’s office, and “brown bagging,” or distribution of a medication directly to the patient (who takes the drug to a physician office for administration). These distribution channels can increase cost due to wastage because complex medications often require therapy modification before administration, but when a product has been previously dispensed, the medication cannot be reused for a different patient and must be discarded. (2) Moreover, given that many of these products require very specific handling instructions (e.g., cold chain only) product integrity and chain of custody would be called into question.
In-office provider infusion centers and freestanding ambulatory facilities can help reduce healthcare costs while improving patient experience and health outcomes without the need for a specialty pharmacy mandate. These care sites have been documented to be at least 50% lower cost than a hospital setting while maintaining the same quality standards and health outcomes. (3) Furthermore, in-office provider infusion centers and freestanding ambulatory facilities improve patient experience and access compared to other alternatives and can save overall healthcare costs by deterring adverse events and costs associated with patients failing to remain adherent to their prescriptions. (4)
- PharmaJet. “Fear of Needles: The Fatal Phobia.” PharmaJet. https://pharmajet.com/fear-needles-fatal-phobia/.
- Catizone, Carmen. “White and Brown Bagging Emerging Practices, Emerging Regulation.” National Association of Boards of Pharmacy. April 2018. https://nabp.pharmacy/wp-content/uploads/2018/04/White-Bagging-and-Brown-Bagging-Report-2018_Final-1.pdf
- Bunger, Anna, Madeleine Cline, and Katie Holcomb. “Commercial Specialty Medication Research: 2019 Benchmark Projections.” Milliman. December 2019. https://www.milliman.com/en/insight/commercial-specialty-medication-research-2019-benchmark-projections
- Giese-Kim, May Wu, et al. “Home Infliximab Infusions are Associated with Suboptimal Outcomes Without Cost Savings in Inflammatory Bowel Disease.” The American Journal of Gastroenterology. July 22, 2020. https://journals.lww.com/ajg/Abstract/9000/Home_Infliximab_Infusions_Are_Associated_With.99217.aspx