Expert: “We Should Not Have Waited Until the Pandemic” to Expand Home Infusion

In an interview with Pharmacy Times at the AMCP Nexus 2023 meeting, Saira A. Jan, MS, PharmD, discussed a novel pilot program in New Jersey aiming to expand home infusion services in oncology. The program has been very successful, with more than 130 patients now enrolled, although Jan said it should not have taken a global pandemic for the health system to expand home infusion services.

Q: What are some of the considerations in home infusion drugs for patient selection, 340B, and monitoring?

A: So, the biggest selection, initially, when we did the pilot, we used all segments—commercial, Medicare, and Medicaid. And what we wanted to see [with] the selection was basically based on a list of drugs that we felt would be more comfortable infusing in a patient's home. But we also wanted to understand how we were going to establish the monitoring, right? So, the first infusion was always given in a hospital setting. And then if the patient was stable, and, you know, willing—so you needed to have the provider approval, as well as the member approval for this process—then they would get the next dose at home. So, the criteria was we started with the list of medications that we thought would be a good starting point, along with the supportive care and other drugs. You know, you wanted to also understand is this a good approach for a patient to get it at home, because, you know, cancer patients could be on multiple medications. So, if they are on a medication, they're coming to the hospital anyway, so did it make sense to have one aspect of chemotherapy be given at home, while the other is being given in the hospital? So, it was a very thought-out process.

And we started by identifying patients who were eligible from the benefit design perspective, from the drug perspective. And then there was a whole work group that we then assessed at the hospital. And then those patients were selected to be in the program, then we started the program, we had a learning curve. And the first month or the second month, we had maybe 5 or 10 patients. And by the end of the pilot, we had not only patients from Horizon Blue Cross Blue Shield, but we extended that to other payers also. So, we have 130-plus patients who have gone through that process right now. And as the comfort level is improving, the list of drugs and the list of membership is improving. So, the criteria is basically not only what drug is eligible for home infusion, but also what are other chemotherapeutic agents that they are getting, and does that make sense for them to get it at home?

Q: Is there anything you’d like to add?

A: The only thing I would say is that, you know, we should not have waited until the pandemic to come up with this pilot. But now the biggest challenge, which I think is not a challenge, is really scaling this to a bigger, you know, process of adoption. We have shared this in New Jersey, and I think my goal is that this should become a routine process, where we have the capabilities to do home infusion oncology, just because of the nature of the condition. The other infusions that are standard site of care that we do in home infusion are not all associated with the side effects that oncology is, you know, associated with. So, from a member perspective, this is an area that needs to be scaled. And one thing I would say is take this pilot as an experience, and I think other states should really scale it to a wider group. And I'm happy if people have questions to reach out to us to understand what our operational challenges were, what processes we put in place, and we are happy to share that with them. But that is the biggest goal now, after establishing this pilot, is to really have this as a routine process of delivery.