Publication No. OTA-H-510. Report examining medicare policies regarding reimbursement for home drug infusion therapy, a medical therapy involving prolonged injection of drugs or biological products. (For abstract of complete report, see J952-24.).

Rare diseases collectively affect millions of Americans of all ages, but developing drugs and medical devices to prevent, diagnose, and treat these conditions is challenging. The Institute of Medicine (IOM) recommends implementing an integrated national strategy to promote rare diseases research and product development.

Infusion therapy -- drug treatment administered intravenously -- was once provided strictly in hospitals. However, clinical developments and emphasis on cost containment have prompted a shift to other settings, including the home. Home infusion requires coordination among providers of drugs, equipment, and skilled nursing care. It describes: (1) coverage of home infusion therapy components under Medicare fee-for-service (FFS); (2) coverage and payment for home infusion therapy by other health insurers -- both commercial plans and Medicare Advantage plans, which provide a private alternative to Medicare FFS; and (3) the utilization and quality management practices that health insurers use with home infusion therapy benefits. Illustrations.