Medicare:

Coverage of Pumps Used to Administer Intravenous Drugs

HEHS-99-16R: Published: Nov 16, 1998. Publicly Released: Dec 16, 1998.

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Pursuant to a congressional request, GAO reviewed the advantages and disadvantages of providing Medicare coverage for disposable infusion pumps, focusing on: (1) the clinical benefits and limitations of disposable infusion pumps; (2) the factors that affect whether a durable or disposable infusion pump is less expensive to use for home infusion; (3) some Medicaid and private insurance plans' home infusion therapy coverage policies; and (4) issues raised by Medicare's policy that links coverage of intravenous (IV) drugs to the use of durable infusion pumps.

GAO noted that: (1) views on benefits and limitations of disposable infusion pumps vary across providers and by type of IV drug; (2) for example, most clinicians and pharmacists GAO interviewed said that disposable infusion pumps can be used to administer IV antibiotics and IV antivirals; (3) they also agreed that disposable pumps were not appropriate for IV pain medications; (4) however, there was no clear consensus on the use of disposable infusion pumps with other infusion drugs, such as certain chemotherapy drugs; (5) factors affecting the relative cost of disposable versus durable infusion pumps are the type of IV drug being administered and the frequency and duration of the patient's infusion therapy regimen; (6) private health insurers GAO contacted pay suppliers a per diem rate for home infusion therapy regardless of the type of pump used; (7) the per diem rate allows suppliers to choose the type of pump they believe will appropriately deliver the IV drugs at the lowest cost; (8) the IV drugs used with infusion pumps are paid for separately; (9) Medicare, on the other hand, generally does not cover self-administered drugs; (10) however, the Health Care Financing Administration's (HCFA) policy is to pay for IV drugs that must be administered with a durable infusion pump; (11) this raises several issues; (12) under current Medicare policy, if disposable infusion pumps become appropriate for a broader range of IV drugs, Medicare coverage of some IV drugs could be eliminated; and (13) if legislation expands Medicare coverage to include disposable infusion pumps, HCFA may need to reconsider its policy for determining which IV drugs to cover.

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