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.

2011

IDF continues to work to advance a solution to the IVIG access problems of Medicare beneficiaries. Working with Senator John Kerry (D-MA) and Congressman Kevin Brady (R-TX) IDF has encouraged the introduction of legislation   that will  establish a  Medicare IVIG access demonstration project that will allow Medicare beneficiaries to receive IVIG in the home setting..

Representatives Brady and 14 co-sponsors have introduced HR 1845, Medicare IVIG Access Act. Original co-sponsors are Representatives Doris Matsui (D-CA)  Chris Van Hollen (D-MD), Marsha Blackburn (R-TN), Michael Burgess (R-TX), Bobby Rush (D-IL), Ron Paul (R-TX), John Sarbanes (D-MD), Lynn Jenkins (R-KS), Marcia Fudge (D-OH), Patrick Tiberi (R-OH0, Ron Kind (D-WI), Adam Schiff (D-CA), Laura Richardson (D-CA), and C.A. Dutch Ruppersberger (D-MD).

Within a couple of weeks the list of co-sponsors grew to 24, by adding:  Representatives Corrine Brown (D-FL), John Culberson (R-TX), Elijah Cummings (D-MD), Michael Fitzpatrick (R-PA), Jim Gerlach (R-PA), Gene Green (D-TX), Ben Ray Lujan (D-NM), Frederica Wilson (D-FL), Bennie Thompson (DMS) and Richard Neal (D-MA)  As a result of IDF’s Advocacy Day, quite a number of additional co-sponsors are expected.

In the Senate, Senators John Kerry (D-MA) and Lamar Alexander (R-TN) introduced S 960, Medicare IVIG Access Act which is identical to HR 1845. Senators Ron Wyden (D-OR), Pat Roberts (R-KS) and Jack Reed (D-RI) are also co-sponsors.

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.

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.960 as well as ask your Representative to support HR 1845 the Medicare IVIG Access Act

Background information is below.