LEADERSHIP FLY-IN Washington, D.C. June 26-28, 2012 US GAPP
LEADERSHIP FLY-IN Washington, D.C. June 26-28, 2012 US GAPP
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IVIG Home Infusion: Getting the Right Care in the Right Setting
Jed Perry Director BioScience Federal Legislative Affairs
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Key Message Cosponsor legislation to improve coverage of IVIG
home infusion therapy for Medicare beneficiaries with Primary
Immune Deficiency to reduce exposure to infection and make care
available in the most appropriate setting.
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What is the Problem? The Medicare Modernization Act (MMA)
provided Medicare reimbursement for intravenous immunoglobulin
(IVIG) therapy infused in the home for patients with primary immune
deficiency disorder (PIDD). MMA did NOT provide reimbursement for
nursing and supplies associated with home infusion therapies,
leaving most unable to utilize the benefit. As a Result: Medicare
patients with PIDD who want to receive their therapy at home must
pay for nursing and supplies themselves, or are limited to
subcutaneous infusion
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Baxters Goal To ensure the right care is provided in the right
setting, patients with already compromised immune systems should
have access to all treatment options to best treat their condition
and prevent unnecessary complications.
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The Solution for Patients Provide Medicare reimbursement for
nursing services and supplies for the administration of IVIG in the
home. Restores intent of Congress to provide reimbursement for IVIG
immune therapy in the home. Exposure to fewer infections. Right
care in the right setting.
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The Medicare IVIG Access Act H.R. 1845 (Reps. Kevin Brady and
Doris Matsui) S. 960 (Sens. John Kerry and Lamar Alexander)
Provides 3-year demonstration project for Medicare reimbursement of
supplies and nursing services associated with intravenous immune
globulin (IVIG) administered in the home for patients with PIDD.
Capped at 4,000 beneficiaries Paid for by Medicare coverage of
disposable pumps for administration of a drug to treat colorectal
cancer in certain cases. Cost of Legislation: ~$40 million over 10
years
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Pay-for/Offset Medicare only pays for electronic durable pumps,
and not the disposable pump for colorectal cancer, under Durable
Medical Equipment (DME) benefit in the home. $3,178 a year for
durable pumps compared to $1,300 a year for disposable pumps..
Pay-for/Offset: Allow disposable pumps to be covered under the DME
benefit.
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Key Messaging 1.The Ask: House: Baxter urges cosponsorship of
H.R. 1845 to improve coverage of IVIG home infusion therapy for
Medicare beneficiaries with Primary Immune Deficiency to reduce
exposure to infection and make care available in the most
appropriate setting. Senate: Baxter urges cosponsorship of S. 960
to improve coverage of IVIG home infusion therapy for Medicare
beneficiaries with Primary Immune Deficiency to reduce exposure to
infection and make care available in the most appropriate setting.
2.More appropriate for these patients, who also may be disabled, to
receive their infusion at home, not in a hospital setting.
3.Legislation is supported by patient groups.