25-006m Alternate Sites of Care Optimization for Therapeutic Infusions - 1st Quarter 2025
Date: 01/06/25
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, PPO) and Exchange members.
Alternative sites of therapeutic infusion care
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, medical offices, or 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 benefits. Health Net 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. Injections (including 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 | Berinert®, Kalbitor® |
HIV3 | Cabenuva |
Hormonal and Metabolic Disorders3 | Eligard®, Fensolvi®, Lupron Depot®, Lupron Depot-PED®, Somatuline® Depot |
Immune Deficiencies and Related disorders | Asceniv®, Bivigam®, 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®, MepseviiTM, Naglazyme®, Nexviazyme®, Vimizim®, Vpriv®, Xenpozyme® |
Movement Disorders | Radicava® |
Multiple Sclerosis2 | Ocrevus® (maintenance dose) |
Ocular Disorders | Tepezza® |
Osteoporosis3 | Evenity®, Prolia®, Xgeva® (maintenance dose)4 |
Paroxysmal Nocturnal Hemoglobinuria | Soliris®, Ultomiris® |
Platelet Disorders3 | Nplate® |
Rare Disorders | Crysvita® |
Sickle Cell Disease | Adakveo® |
Systemic Lupus Erythematosus | Benlysta®, Saphnelo® |
1Health Net prefers these biosimilar products over Remicade®: Inflectra® (infliximab-dyyb), Renflexis® (infliximab-abda)
2First 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.
3Coram can coordinate with CVS Specialty, Inc to have this injection delivered to the doctor’s office for administration.
4First two doses of Xgeva are given in the Ontario and San Diego locations.
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.
If 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.
If the 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 to alternative site of care (including home), Coram contact information is listed below:
Phone: 866-899-1661
Fax: 866-843-3221
For additional information (including patient referrals to alternative site of care), contact the Health Net Pharmacy Team Mailbox and reference the SCOTI Program.
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal.
This information applies to Physicians and Participating Physician Groups (PPGs).