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One Medicare Barrier Down, One to Go

October 31, 2017

As the fight to ensure affordable access to appropriate medication and sites of care continues, recently IDF has been focused on two issues faced by Medicare beneficiaries living with PI, specifically extending the Medicare IVIG Demonstration Project and accelerating the start of the Medicare SCIG home infusion benefit.

Medicare IVIG Demonstration Project Extension

Recently, the Medicare IVIG Demonstration project was extended after being passed in both Houses of Congress and signed into law by the President. The extension will last until December 31, 2020 or until all allocated funds are spent, and enrollment has now begun for new demonstration project applicants.

Beneficiaries who were previously enrolled in the demonstration project as of September 30, 2017, when the project was originally slated to end, were automatically re-enrolled in the demonstration for the extension period and experienced no gaps in coverage.

The Centers for Medicare and Medicaid Services (CMS) has now begun accepting new demonstration project applicants on a rolling basis, and will continue to do so until the demonstration reaches its statutory limit on enrollment and/or funding. Please check the CMS website regularly for the most up-to-date information as well as details on how to apply.

While extension of the demonstration project is a temporary solution, we are pleased that individuals with PI who are in the demonstration project will continue to have their infusions covered while IDF advocates for Congress to make this a permanent benefit.

Accelerating the Start of the Medicare SCIG Home Infusion Benefit

Now, our community is focusing on accelerating the start of the Medicare SCIG home infusion benefit. The 21st Century Cures Act (Cures), passed by Congress in December 2016, increased funding for important research, but unfortunately this act included revised reimbursement provisions that threaten access to treatment for Medicare beneficiaries living with PI who receive subcutaneous immunoglobulin therapy (SCIG). To “pay for” the provisions of Cures, effective January 1, 2017, Congress significantly reduced reimbursement for the cost of drugs, including immunoglobulin (Ig). As a result of this reduction, some providers have stopped providing services, some refuse to take new Medicare beneficiaries and some are waiting to see if Congress will fix this problem.

IDF campaigned and succeeded in getting language in Cures that would authorize Medicare to develop reimbursement categories to pay for the services needed to train and monitor people who receive SCIG. While the language recommended by IDF was in the legislation, the start date was January 1, 2021, a four-year delay from when the payment reductions began. The gap in reimbursement has created a gap in care. Moving the start date to January 2019 will address this gap and makes financial sense since the Congressional Budget Office (CBO) estimated this provision would save the government money, and acceleration of the start date would expedite the realization of such savings. IDF is currently advocating for Congress to address this gap in care and will keep the PI community abreast of updates as they occur.

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