Medicare expands home infusion access, but adds payment penalties for remote care
S. 1058 — Preserving Patient Access to Home Infusion Act · Filed by Mark Warner (D-VA) · 1 cosponsor · Introduced Mar 13, 2025 · Referred to committee
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What it does
This bill expands Medicare coverage for home infusion therapy by adding pharmacy services to the list of covered services, allowing nurse practitioners and physician assistants (not just doctors) to establish and review treatment plans, extending coverage to non-pump drugs like antibiotics and antivirals, and adjusting payment rates. Starting January 1, 2026, Medicare will pay for infusion services even when a supplier is not physically present (at 50% of the normal rate), and will no longer separately reimburse for basic supplies like tubing and syringes when they are furnished with the infusion drug on the same day.
Why we flagged it
The bill's core function is to broaden Medicare coverage for home infusion therapy—adding pharmacy services, expanding eligible practitioners, including non-pump drugs, and restructuring payment. This is a straightforward healthcare access expansion, not a carve-out or deregulation.
What the text implies
- The 50% payment reduction for remote administration (when supplier not physically present) may incentivize in-person visits even when clinically unnecessary, potentially increasing costs and patient burden.
- Bundling of supplies with infusion drugs eliminates separate reimbursement for tubing, catheters, and dressings—suppliers may absorb costs or shift them to patients if not covered under the consolidated rate.
The full analysis lists 4 implications of this text.
Who stands to gain
home infusion therapy suppliers; pharmacy benefit managers; durable medical equipment (DME) suppliers