Many home infusion pharmacies are aiding patients’ transition into home life after hospitalization. This exemplifies the continuing involvement of these specialized pharmacies as frontline health care providers during the coronavirus disease 2019 (COVID-19) pandemic. Although many patients are benefiting from access to pharmacists in a variety of settings, the home infusion pharmacy arena is often overlooked, but this critical area of pharmacy care is an important piece of the health care puzzle during the pandemic.

One home infusion pharmacy provider, Vital Care Home Infusion Services, based in Meridian, Mississippi, helps clinics and hospitals care for patients who need intravenous (IV) infusion or other medical services that can be provided at home. By transitioning patients back home from doctors’ offices and hospitals, pharmacies such as Vital Care provide an important service by reducing the burden in these unprecedented times. Unique to Vital Care is its franchise model, which offers the benefits of locally owned and operated locations that are supported by a national office staff of specialists in billing, insurance approvals, nursing, payment, pharmacy, and quality management.

Home infusion pharmacy providers of this type have expertise in sterile drug compounding; they provide care to patients with acute or chronic conditions that generally pertains to the parenteral administration of biologics, drugs, and nutritional mixes through catheters, needles, or both. These pharmacies typically provide comprehensive professional pharmacy services, care coordination, infusion nursing services, supplies, and equipment.

“Fortunately, we have been proactively expanding our reach and market share for the last several years, giving us the infrastructure to continue meeting increased demand,” said Johnny Bell, president and founder of Vital Care. “We are committed now more than ever to utilizing our capacity and expertise to help people across the country who can benefit from home infusion.”

Home infusion pharmacies provide primary treatments, such as total parenteral nutrition and enteral nutrition, anti-infective therapy, hydration, inotropic therapy, immunotherapy, pain management, hemophilia services, and specialty medications. In the case of Vital Care, because it offers franchise opportunities to local pharmacy providers, it is able to provide corporate access to administrative and clinical experts in health care, securing drugs and supplies from pharmaceutical companies and handling much of the billing and insurance aspects of this type of pharmacy business model. The model is intended to free up local pharmacist-owners to work directly with case managers, doctors, home health agencies, and nurses to transition patients into the home setting.

Organizations such as Vital Care are also working behind the scenes with the National Home Infusion Association (NHIA) and other groups to promote new legislation that would expand access to home infusion treatments for patients who need IV medications but do not otherwise need to be hospitalized. The Centers for Medicare & Medicaid Services (CMS) only covers a limited set of drug therapies for home infusion reimbursement, whereas most private insurance payors cover a more comprehensive list of these treatments. Now is an excellent time, during the COVID-19 crisis, for CMS to expand coverage for home infusion, as it is clear that this is a preferred path for patients who need to stay safe and at home.

“There is already a comprehensive infrastructure and support system in place to make sure that home infusion can happen safely,” said Logan E. Davis, PharmD, MBA, the director of franchise development at Vital Care and chairman of the NHIA.

“Our home infusion pharmacies across the country have implemented screening protocols and best practices to ensure that, when necessary, nurses are able to safely go into the home and administer infusions and leave without risking spread of the virus,” he said. “Also, the vast majority of infusion drugs do not require a nurse to be in the home for every day of their administration.”

An example is the IV antibiotics for conditions such as a skin infection requiring weeks of infusions. Such therapy is self-administered by patients every day, all over the country, and paid for by private insurers. This is a gap that CMS has long had and has been encouraged to address. Virtually every other payor has a benefit that reimburses home infusion providers for each day of infusion. For this reason, it is critical that CMS expand coverage, particularly during a public health emergency.

“I was a hospital-based pharmacist for 15 years previously. We had many patients who could have been served in the home instead of the hospital,” said Ed Eiland, PharmD, MBA, BCPS, FASHP, CEO of Vital Care.

“Home infusion is the right solution for patients completing their intravenous medication therapies for acute illness, as well as those individuals with chronic conditions,” he said. “The coronavirus has put an added emphasis on this, and we are encouraged to see so many people now realizing that.” Hospital administrators, nurses, patients, and physicians are increasingly looking to depend on a home infusion pharmacy to deliver patient care. Relying on such experienced pharmacies is a solution that cannot afford to be overlooked on many levels.
 
Ned Milenkovich, PharmD, JD, is cochair of the health care practice at Much Shelist, PC, in Chicago, Illinois, and former vice chairman of the Illinois State Board of Pharmacy.