21st Century Cures Act is cutting treatment for Medicare beneficiaries
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As the nation considers the important issues related to access to healthcare, there is one issue impacting Medicare beneficiary access to lifesaving therapies that requires immediate action to fix to a problem created late last year as part of the 21st Century Cures Act.

I have a rare, chronic condition known as a primary immunodeficiency disease (PI). This means my immune system doesn’t work like most people’s do. In order to protect myself from infections, I rely on medication known as immunoglobulin or Ig replacement therapy to replace the antibodies my body does not produce.

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In my case, I receive my Ig replacement therapy in my home by using an infusion pump to inject the medication subcutaneously or just under my skin. Known as SCIG, this method allows me to infuse my medication more regularly for shorter periods of time than what would be required if I received treatment intravenously.

I have been taking the same medication via home infusion since my diagnosis nearly a decade ago and have been doing very well, but will need to continue on this therapy for the rest of my life to stay healthy.

Unfortunately, under a change to the law governing how Medicare pays for such therapies that was enacted late last year, I was informed on March 2, 2017 that my home infusion provider will no longer supply me (or other Medicare Part B beneficiaries) with my prescribed treatment. 

In December as part of the 21st Century Cures Act, Congress changed the mechanism used for Medicare reimbursement for treatments like SCIG delivered using a pump or other type of durable medical equipment. This change immediately reduced the provider payment for these services. 

In the same law, Congress did establish a new home infusion benefit that will institute a reimbursement payment for the essential services of training and monitoring patients to self-infuse safely and bring Medicare into line with policies that have long been the norm for private insurers.

However, while payments were reduced as of January 1, 2017, the new home infusion reimbursement benefit is not scheduled to start until 2021. The consequences of reducing the reimbursement of infusible drugs without instituting at the same time a reimbursement for the necessary professional services to train and monitor patients for self-administration of the drugs are happening right now. 

Already a number of specialty pharmacies are not taking new Medicare beneficiaries, forcing them to find sites of care for receiving intravenous immunoglobulin (IVIG), which may not be the best option for them. 

Providers simply will not be able to afford to continue treating existing Medicare beneficiaries who rely upon SCIG. This is now a medical emergency. The non-alignment of the two provisions creates a four-year gap in payments, meaning that people like me now have our treatments denied as home infusion companies consider whether or not to continue providing such care to Medicare beneficiaries.

My ability to receive treatment in the home is more convenient, safer and more cost-effective to the Medicare program. If people with PI cannot receive their treatment in the home setting, their choice will be more expensive sites of treatment, such as hospital outpatient infusions centers. This makes no sense and would contradict a movement toward lower cost settings of care when clinically appropriate. It’s also important to note that some people with PI can only take SCIG, as they have bad adverse reactions and/or poor venous access, making IVIG impossible for them. And besides, the last thing a person who is already immunocompromised needs is to have infusions in crowded, germ infested settings.

To prevent this from occurring, we need Congress to act as quickly as possible to accelerate the start date of the new Medicare home infusion benefit. By moving up this date to fiscal year 2018, Congress will not only address the gap created late last year but will also accelerate implementation of a provision that the Congressional Budget Office (CBO) has estimated will save Medicare money over the years to come.

Accelerating the start of the new Medicare home infusion benefit is a win-win that will protect Medicare beneficiaries whose lives depend on access to such treatments while accelerating a cost-savings initiative.

Congress needs to act – right now – to fix this problem as it is resulting in a large scale disruption to care for Medicare beneficiaries whose lives depend on access to such lifesaving treatments.

Laura Coleman, a cancer survivor from Auburntown, Tenn., is a patient that has been denied treatment. 


The views expressed by this author are their own and are not the views of The Hill.