PROPOSAL:



PROPOSAL: Home Intravenous Therapy

SUBMITTED BY: Board of Directors

DATE: July 16, 2017

SITUATION:

1. CSHP Professional Policy #2015-04 directs CSHP to adopt ASHP policies and other guidance documents as CSHP Professional Policy

2. To adopt as CSHP policy all ASHP Policy Positions, Guidelines, Bulletins, and all official Statements in the current edition of the Best Practices for Health-System Pharmacy of the ASHP, except when such policies differ substantially from CSHP policy.

3. To endorse the use of ASHP Position Statements, Guidelines, and Technical Assistance Bulletins by its members in their practice settings.

4. CSHP will review all ASHP Policy Positions by 2020 for possible adoption as CSHP Professional Policy.

5. CSHP does not have a policy on Home Intravenous Therapy.

6. ASHP has 2016 policy 1623 Home Intravenous Therapy that supersedes ASHP policy 0414:

1623

HOME INTRAVENOUS THERAPY

To support the continuation of a home intravenous therapy benefit under federal and private health insurance plans and expansion of the home infusion benefit under Medicare at an appropriate level of reimbursement for pharmacists’ patient care services provided, medications, supplies, and equipment.

Rationale

The Medicare Modernization Act of 2003 created an outpatient prescription drug benefit for Medicare beneficiaries, Medicare Part D. The new benefit provided prescription drug coverage for Medicare beneficiaries by private health plans and pharmacy benefit managers (PBMs). Although the law requires certain basic coverage packages across the plan continuum, it provides no coverage for services and supplies used in home infusion. The result is that the drug products used in home infusion may be covered, but the supplies (e.g., IV bags, tubing) and services related to providing and administering the drug products are not.

Over the years, efforts have been made to address this gap by moving coverage for the drug products from Part D to Part B, and including supplies and services within that coverage. Initially, this effort resulted in federal legislation to move home infusion coverage from Part D to Part B; however, projected costs to the Medicare program have prevented Congress from passing the legislation. ASHP supports continuation of a home intravenous therapy benefit under federal and private health insurance plans and expanding the home infusion benefit under Medicare to include supplies and services related to providing and administering the therapy.

7. Occasionally, home intravenous therapy patients are discharged from a hospital with insufficient time for the home infusion pharmacy to coordinate and provide nursing care, intravenous solutions, medications, ancillary supplies, and equipment to the patient’s location prior to the time of the next dose. This failure in the transition of care process may result in preventable adverse events.

TARGET:

1. CSHP provides resources to its members, their patients, and the public per the 2017-2021 Strategic Priorities and Goals.

2. CSHP develops professional policy in congruence with other professional organizations, but adopts policy as an independent professional society.

3. CSHP has a professional policy that addresses home intravenous therapy and supports the continuation of a home intravenous therapy benefit under federal, state, and private health insurance plans. This policy should also support expansion of the home infusion benefit under Medicare and Medicaid at an appropriate level of reimbursement for pharmacists’ patient care services provided, medications, supplies, and equipment to provide optimal therapy for patients.

PROPOSAL:

1. Adopt the following as CSHP Professional Policy:

Home Intravenous Therapy

The California Society of Health-System Pharmacists:

1. Supports the continuation of a home intravenous therapy benefit under federal, state, and private health insurance plans.

2. Supports expansion of the home infusion benefit under Medicare and Medicaid at an appropriate level of reimbursement for pharmacists’ patient care services provided, and which includes medications, supplies, and equipment to provide optimal therapy for patients.

3. Encourages health-systems and providers to ensure that transitions of care into the homecare environment includes sufficient information and sufficient time for the home infusion pharmacy to provide nursing care, intravenous therapy, medications, ancillary supplies, and equipment to the patient in an optimal and timely manner.

RESOURCES REQUIRED FOR PROPOSED ACTION(S)

Financial: Minimal

CEO time: Minimal

Staff time: Minimal

CSHP BOARD ACTION:

The CSHP Board of Directors approved this proposal on July 14, 2017 for consideration by the 2017 House of Delegates

ACTION:

☐ Bylaws update

☐ Rules and Procedures of the House of Delegates

☐ Update Administrative Policy catalog

☒ Update Professional Policy catalog

☐ Staff Procedural manual

☐ CCTF’s volunteer hand book

☐ Minutes only

☐ Any other (please state)

HOD ACTION:

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PROPOSAL C.2

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