New Medicare Law to Cover Home Infusion for Alpha-1 Deficiency Starting 2027—But Not for Part C Enrollees

The John W. Walsh Alpha-1 Home Infusion Act of 2025 is a big deal for a small, specific group of people: those living with Alpha-1 Antitrypsin Deficiency Disorder (AATD) who have developed emphysema. Essentially, this legislation mandates that Medicare will now cover the specific, ongoing maintenance therapy—called augmentation therapy using an Alpha-1 Proteinase Inhibitor—needed to manage this severe hereditary condition, provided the treatment happens at home.

This isn't just about covering the drug itself; it’s about making sure the whole process works. The bill directs Medicare Part B to create a payment system for the qualified home infusion therapy suppliers. This system covers two key components: the intravenous administration kits and up to two hours of nursing care required during the infusion session. Starting January 1, 2027, Medicare will pay the supplier 80% of the lesser amount between what they charge and a rate set by the Secretary for these kits and nursing services. This is a crucial step that ensures the supplies and professional help needed for safe home treatment are covered, making a huge difference in the daily lives of patients who need regular, ongoing infusions.

The Convenience of Care at Home

For AATD patients, this new coverage means a significant improvement in quality of life. Instead of having to travel frequently to a clinic or hospital for their maintenance therapy, they can now receive the necessary treatment—which must be overseen by a physician, nurse practitioner, or physician assistant—in the comfort of their own home. Think about a person with severe emphysema; minimizing travel and exposure to public spaces is a massive health benefit. By specifically covering the kits and up to two hours of nursing care, the bill smooths out the logistics of this complex, chronic treatment. The law also makes sure this specialized home infusion coverage isn't accidentally lumped in with standard home health services, keeping the payment pathway clear for suppliers.

The Catch: Who Gets Left Out?

While this bill is a clear win for many in the AATD community, it contains a significant exclusion that busy people need to pay attention to. The new coverage explicitly requires the patient to be enrolled in Medicare Part A and Part B, and they cannot be in a Medicare Advantage (MA) plan under Part C. This is a huge carve-out. Medicare Advantage plans are increasingly popular, offering bundled benefits often with lower premiums. If you are an AATD patient currently relying on a Part C plan, you will have to switch back to traditional Medicare (Parts A and B) to access this specific home infusion coverage starting in 2027. This creates an immediate disparity, forcing patients to choose between their preferred comprehensive MA plan and essential, life-saving home therapy coverage. It’s a detail that could cause real headaches for patients trying to manage their healthcare choices.