Medicare Patient IVIG Access Issue
Many members of the primary immunodeficiency community experience delays in and denial of treatment due to insufficient Medicare reimbursement. A report from the Office of the Inspector General showed Medicare reimbursement for IVIG is lower than the cost many providers pay for the product. As a result, a number of physicians and hospitals cannot afford to administer IVIG treatment to Medicare patients. This serious problem affects the entire community as an increasing number of private pay insurers are following Medicare's lead to determine reimbursement rates for IVIG.
Medicare beneficiaries are also denied IVIG in the home setting, forcing patients with primary immunodeficiency diseases (PIDD) to seek care in more expensive and less healthful care settings.
2009
In 2009 legislation was introduced into both the United States Senate and United States House of Representatives. Senators John Kerry (MA), Lamar Alexander (TN), Sheldon Whitehouse (RI), Ron Wyden (OR) and Sam Brownback (KS), introduced the Senate Bill S. 701, The Medicare Patient IVIG Access Act . In the House, Representatives Israel (NY), Brady (TX), Schwartz (PA), Moore (KS), Blackburn (TN) and Grijalva (AZ) introduced HR 2002. Both bills offer a solution to the current IVIG access crisis by establishing appropriate reimbursement in all sites of care for our patients. Both also change current policy regarding Medicare coverage of home infusion to include the cost of items and services related to the administration of IVIG in the home for primary immune deficient patients.
Neither bill passed because the Congressional Budget Office (CBO) did not analyze and determine the fiscal impact of the bills on the Medicare budget (which is required by law). Their inaction was the result of the huge demands placed on the CBO by the acrimonious health care reform debate that dominated every other issue before Congress last year.
Senator Kerry filed an amendment during the health care reform debate that authorized a demonstration project to minimize the potential cost and provide a larger incentive to be accepted. However, even the amendment couldn't get a "score". As a result, nothing happened.
2010
With health care reform signed into law, IDF continues to work to advance a solution to the IVIG access problems of Medicare beneficiaries. Working with Senator John Kerry (D-MA) and Congresswoman Doris Matsui (D-CA), IDF has encouraged the adoption of the Medicare IVIG Access Demonstration Project language contained in the above mentioned Kerry Amendment.
Congresswoman Matsui has introduced HR 5597, Medicare Patient IVIG Access Demonstration Project. Original co-sponsors are Representatives Kevin Brady (R-TX), Chris Van Hollen (D-MD), Jim Gerlach (R-PA), Bruce Braley (D-IA), Lee Terry (R-NE), Bobby Rush (D-IL), and Joseph Pitts (R-PA).
The bill authorizes a three year demonstration project allowing for the payment of home infusion services for patients with PIDD. The bill also authorizes government studies of other obstacles to access IVIG care. Instead of costing Medicare, the bill will save Medicare over $210 million over the next 10 years because it includes a budget offset or "pay-for" provision.
In the Senate, Senator Kerry decided not to introduce a new bill but rather plans to introduce his previous amendment as an amendment to an appropriate health legislative vehicle this year.
IDF is working in coalition with other patient organizations and physician organizations including the American Academy of Allergy Asthma and Immunology (AAAAI) and the Clinical Immunology Society (CIS). With the strong leadership of the policymakers who have signed on to support this legislation, IDF hopes to improve access to treatment and the quality of life of the countless patients who struggle with negative health outcomes, increased intervals of care, change in site of infusion, difficulty finding providers, and denial of treatment.
However, we can't do it alone! Access to IVIG treatment is a serious problem affecting more and more patients every day. Please visit the IDF Action Alert to tell your legislators how important IVIG is to you and your loved ones and ask your Senators to co-sponsor and support S.701 and Senator Kerry's effort to put in place a Demonstration Project, as well as ask your Representative to support HR 5597 the Medicare Patient IVIG Access Demonstration Project.
For Your Representatives
HR 5597: Medicare IVIG Demonstration Project - Rep. Doris Matsui (D-CA), et al.
Medicare IVIG Demonstration Project Summary
HR 5597 Dobson-DaVanzo Cost Estimate
HR 2002: Medicare Patient IVIG Access Act - Rep. Steve Israel (D-NY), et al.
Medicare Patient IVIG Access Act of 2009 Summary
Medicare Patient IVIG Access Act of 2009 Section-by-Section Summary
For Your Senators
S. 701: Medicare Patient IVIG Access Act - Sen. John Kerry (D-MA), et al.
Medicare Patient IVIG Access Act of 2009 2 Page Summary
Medicare Patient IVIG Access Act of 2009 Section-By-Section Summary
