How are payers’ attitudes about home infusion evolving in the COVID environment?

  • Kevin Patterson
  • Dave Evans
  • Chip Frazier
  • Tushar Padwal
  • Priyanka Shanbhag
  • Sharavanan Ramakrishnan

Payers have covered home infusion services as part of the medical benefit for years. With the effects of COVID-19 restricting access to hospitals and physician offices for elective procedures, the availability of home infusion services has increased in importance.

Insurance companies and PBMs have been working to shift care to less expensive sites of service in recent years. Prior to the COVID-19 pandemic, home care has been an initiative for many payers seeking to reduce the cost of care away from outpatient hospitals and physician offices.

To better understand payers’ perception of home infusion therapy services, MME conducted an online survey with 24 pharmacy and medical directors (representing 229 million covered lives) selected from MME’s proprietary payer panel. All respondents were directly involved in formulary decision-making and contracting. 

Our survey found:

  • 96% of the covered lives had access to home infusion services. Home infusion services were provided by major medical and pharmacy benefit managers.
  • 82% of the covered lives provided access for patients if requested by the attending physicians.
  • Only 5% of covered lives were in plans that had restricted access to specific medications.
  • Plans representing 35% of covered lives expanded access to home infusion as a result of COVID-19.
  • Approximately 90% of respondents expected home infusion to continue to expand in the future.

As healthcare evolves, expect to see home infusion become a more important channel for care. COVID-19 has forced providers to be more creative and aggressive in the use of home care as part of treating patients—a trend that Payers would like to see continue to expand.  

Please contact us today if you would like to discuss these results in greater detail or to analyze the benefits versus drawbacks of factoring home infusion into your PRMA decisions. We are ready and here to help. 
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