Infusion Therapy Site of Care Optimization

Industry analysts predict a 7.0% increase in medical costs year-on-year in 2024 in both Individual and Group markets, a notable increase from previous years. This upward trend is primarily due to the rapidly escalating costs associated with specialty drugs, which predictions show will continue to grow at double-digit rates over the next five years, accounting for over half of drug spends.

From health plans to self-insured employers, third-party administrators (TPAs) and brokers, there is increased pressure to better address the cost of infusion therapies. The expense of infusion therapy varies depending upon the type and dosage of medication with a significant percentage of patients requiring treatments on a weekly or monthly basis.

What are Specialty Drugs?

Specialty drugs are often biologics - drugs derived from living cells that are injectable or infused (although some are oral medications). They are used to treat complex or rare chronic conditions such as cancer, rheumatoid arthritis, hemophilia, H.I.V. psoriasis, inflammatory bowel disease and hepatitis C.

A year of infusion therapy treatment can range from several thousand to tens of thousands of dollars. For example, the annual cost of rheumatoid arthritis (RA) infusion therapy in a hospital setting routinely costs payers between $36,000 and $47,000.

As payers seek to regain control of their pharmacy and medical spending, site of care (SOC) optimization is an opportunity to capture savings.

While alternative SOC options got introduced in the 1980s, there are increased pressures in 2024 for cost-containment at every level of healthcare delivery. Along with advances in the clinical administration of therapies, new technologies and increased demand for quality improvements, there are now multiple opportunities for SOC optimization. For individuals requiring long-term therapy, inpatient care is not only tremendously expensive ($6 billion annually nationwide) but also prevents the individual from resuming a normal lifestyle and work activities.

A cascade of specialty drug launches is expected throughout 2024, adding to the massive market. SOC optimization can unlock even greater value by enabling patients to receive specialty infusion medication, allowing for more responsive care and saving payers on overall costs. So far in 2024, the FDA has approved 22 novel drugs.

AscellaHealth releases a quarterly Specialty & Rare Pipeline Digest™, the industry’s most comprehensive resource of new, pending and upcoming specialty and rare disease drug launches, cell and gene therapies (CGT), biosimilars and generics. This complimentary digital publication provides timely product updates to support the needs of the specialty drug market, industry stakeholders and key decision-makers.

The Q2 2024 Digest indicates a notable increase in specialty drug approvals and the introduction of additional cell and gene therapies compared to the previous quarter. This upward trend underscores the growing demand for specialty medications and points to the essential role of AscellaHealth in addressing the needs of millions of individuals worldwide who are affected by complex, chronic conditions or rare diseases.

Working with providers to transition patients from high-cost environments like large hospitals with inpatient and outpatient facilities to more economical settings, such as physicians’ in-office infusion suites or stand-alone Infusion Centers, has been advantageous in its approach. Alternate sites of care not only offer cost savings but also deliver a more comfortable care environment and higher-quality care with flexible scheduling, aligning seamlessly with the preferences of both patients and payers.

At AscellaHealth, we put patients at the center of everything we do, and this has led us to emphasize the importance of optimizing SOC in our offerings to enhance access to more convenient, quality-focused settings, increase patient engagement and compliance rates, improve clinical outcomes and lower costs. For example, our professional team has leveraged their extensive industry knowledge and expertise to introduce a proprietary Home Infusion Pharmacy Network offering payers and patients a less intrusive and more cost-effective option for infusion therapy. This nationally recognized solution is acclaimed for effectively reducing costs without compromising the quality of care in the administration of specialty medications.

Home infusion therapy is highly effective in improving patient outcomes. One study found that, compared to medical setting infusion patients, home infusion patients were no more likely to have adverse drug events or side effects. Similarly, clinical outcomes were as good if not better. For example, home infusion patients with hemophilia have a 40% reduction in the likelihood of hospitalization for bleeding complications. Patients also overwhelmingly preferred home infusion and reported greater physical and mental well-being, as well as less disruption to daily life and a reduction in burden for caregivers. In addition to better patient outcomes, home infusion costs were significantly lower than medical setting infusion costs, with savings of between $1,928 and $2,974 per treatment course.

Cost Reduction

It will come as no surprise for payers to learn that the same therapies, administered using the same method, can be more than two to three times more expensive in the hospital versus a stand-alone infusion center. Industry sources report that hospital outpatient department (HOPD) infusions cost 70% more on average than a physician’s office for the same treatment.

Large payers are growing their SOC Optimization programs. At Cigna, for example, only one infusible drug was on its SOC medical policy at the start of 2017. By 2022, that number grew to 135, including 26 oncology and 109 non-oncology agents.

The chart below demonstrates the increasing number of drugs added to Cigna’s SOC medical policy:

Source: Site-of-Care Shock Looms for Infusion Services (specialtypharmacycontinuum.com)

Real-World Cost Savings

See this cost comparison for Remicade, a specialty drug targeting a specific protein in the immune system to help control inflammation. Remicade can reduce signs and symptoms, induce and maintain remission, promote intestinal healing and reduce or stop the need for steroids.

Source: National Infusion Center Association. Site of Care Optimization - National Infusion Center Association

Benefits of AscellaHealth’s SOC Optimization

With the overwhelming evidence of success, several health plans, self-insured companies, at-risk providers, PBMs, TPAs/Brokers and other payers have begun working with AscellaHealth. This partnership has quickly allowed them to implement and scale their own SOC Optimization programs and provided significant value in applying a high level of expertise to the management of specialty drugs. The AscellaHealth Home Infusion Pharmacy Network reflects:

• Expertise in Specialty Conditions & Rare Diseases: Many specialty products treating patients with chronic, complex conditions have intricate routes of administration. AscellaHealth hand-selects each partner as a disease state site of excellence to ensure they meet the specific clinical demands, deliver high-quality care and provide patient flexibility and convenience for the best possible outcomes.

• Dedication to Quality of Care: Collectively, the care sites contribute to a higher quality of life by improving patient access to care, reducing time away from work or school and fostering independence for patients living under otherwise rigid medical parameters.

• Efficient Clinical and Commercial Operations: On-demand, rapid orchestration – sometimes within 48 hours – is crucial to ensure timely treatment, given the potential disruptions to delivery timelines due to patient-specific issues.

• Patient-Centric Approach to Care: Care sites play a pivotal role in supporting patient compliance during the first 30 days post-infusion, as well as for long-term monitoring to assess the durability of the treatment. AscellaHealth’s patient engagement tools are essential to ensure compliance and optimize care management. Communicating with the care coordination and personalized support teams is easy and convenient with comprehensive, innovative and cutting-edge tools. Our teams can seamlessly engage patients, break communication barriers down and ensure optimal therapeutic outcomes. Automated workflows ensure accuracy, speed-to-fulfillment, and initiation of treatment. Capabilities also include the delivery of infusion products to the home, doctor's office, or other locations, emphasizing timely administration and ongoing support. Our services offer side effects management, adherence and refill reminders, and late-to-refill notifications, ensuring continuous patient engagement and compliance with treatment protocols.

• Accreditation Excellence: All AscellaHealth’s SOC partners are accredited and licensed in one or multiple states. Furthermore, our network Pharmacies are accredited by one of many accrediting organizations (AOs), including The Joint Commission, Accreditation Commission for Health Care (ACHC), Utilization Review Accreditation Commission (URAC) and more.

For further information on AscellaHealth, visit www.ascellahealth.com or contact businessdevelopment@ascellahealth.com