23-193m Site of Care Optimization for Therapeutic Infusions - 1st Quarter 2023
Date: 02/28/23
Review changes that improve patient experience, enhance patient safety and encourage medication adherence
Stay up to date with information about alternative sites of infusion care for Commercial (HMO, POS, EPO, HSP, PPO) and Exchange members.
Alternative sites of infusion care for Commercial and Exchange members
Health Net* has partnered with Coram® CVS Specialty™ Infusion Services as the designated preferred provider for site of care optimization for therapeutic infusions (SCOTI). Members have the option to transition infusions from the hospital to the home and an ambulatory infusion suite (AIS) located in the Ontario and San Diego facilities. Alternate site of infusion care is part of a member's standard benefit. The Plan has options available for members who are being treated with any of the infusion products listed in the table below.
Coram provides:
- Experience. More than 35 years of expertise in specialized infusion care. The only national home infusion provider accredited by The Joint Commission.
- Safety. Certified clinicians and nurses deliver and track complex drug therapy to ensure patients receive high-level care.
- Convenience. Scheduling is easy with in-home and AIS-based infusions located in Ontario and San Diego. Patients can enjoy flexibility, independence and enhanced quality of life. Clinical support is available to patients 24 hours a day, seven days a week.
- Lower costs. Infusions may be provided at a lower cost to promote compliance to therapy, improve outcomes and reduce health costs.
Products eligible for home infusion
Disorder | Product |
|---|---|
Alpha-1 Antitrypsin Deficiency | Aralast™ NP, Glassia®, Zemaira® |
Amyloidosis | Onpattro® |
Asthma | Cinqair®, Fasenra®, Nucala®, Xolair® |
Autoimmune Disorders | Actemra®, AvsolaTM, Entyvio®, Inflectra®, Orencia®, Remicade®1, Renflexis®, Simponi Aria® |
Hereditary Angioedema | Cinryze® |
Immune Deficiencies and Related disorders | Asceniv®, Bivigam®, Carimune®, Cuvitru®, Flebogamma®, Gammagard® Liquid, Gammagard® S/D, Gammaked™, Gammaplex®, Gamunex®-C, Hizentra®, Hyqvia®, Octagam®, Panzyga®, Privigen®, Xembify® |
Lysosomal Storage disorders | Aldurazyme®, Cerezyme®, Elaprase®, Elelyso®, Fabrazyme®, Kanuma®, Lumizyme®, Naglazyme®, Vimizim®, Vpriv® |
Movement disorders | Radicava® |
Multiple Sclerosis2 | Ocrevus® (maintenance dose) |
Ocular Disorders | Tepezza® |
Paroxysmal Nocturnal Hemoglobinuria | Soliris®, Ultomiris® |
Rare Disorders | Crysvita® |
Sickle Cell Disease | Adakveo® |
Systemic Lupus Erythematosus | Benlysta® |
Home infusion coverage
Home infusion services are a covered benefit for Commercial and Exchange members. Use of the SCOTI program depends on whether Health Net or the member’s assigned participating physician group (PPG) is financially responsible for the service.
PPGs should consult the Health Net Injectable Medication HCPCS/DOFR Crosswalk to determine the DOFR categorization of medications to determine the financial responsibility. The intent of the DOFR category of Home Health is to include only those medications in the crosswalk with the Home Health Infusion category.
- Health Net has financial responsibility: Use Coram CVS Specialty Infusion Services for the home infusion medications included in this communication. Coram will work directly with the provider to arrange home infusion. This includes obtaining required documents for prior authorization and scheduling the member for services.
- PPG has financial responsibility: PPGs that have financial responsibility for home infusion are not required to use Coram CVS Specialty Infusion Services or any of the home infusion medications included in this communication. Providers should work directly with the member’s assigned PPG to arrange home infusion using the PPG’s contracted home health vendor.
Additional information
For patient referrals or additional information, contact Health Net Pharmacy Team Mailbox and reference the SCOTI Program.
1 Health Net prefers these biosimilar products over Remicade®: Inflectra® (infliximab-dyyb), Renflexis® (infliximab-abda)
2 First dose of Ocrevus is infused in the Ontario and San Diego locations. Other multiple sclerosis agents, such as Lemtrada and Tysabri, are also eligible for alternative site of infusion care in the Ontario and San Diego locations.
This information applies to Physicians and Participating Physician Groups (PPGs).