New Bill Expands Medicare Coverage for Complex Home Infusion Therapy, Starting Next Year

If you or a loved one relies on complex medications delivered via IV or subcutaneously, you know the drill: frequent trips to a clinic or hospital for infusions. The Joe Fiandra Access to Home Infusion Act of 2025 is looking to change that by expanding what Medicare covers for home care.

Starting one year after the bill becomes law, Medicare will begin covering specific external infusion pumps and the drugs used with them when administered at home. This is a big deal because it bypasses some existing rules for durable medical equipment, making it easier to get hospital-level care delivered right to your living room. The goal is to make home infusion therapy a viable option for treatments that currently require a clinical setting.

The Fine Print: Who Qualifies for Home Care?

This isn’t a blanket expansion; it’s highly targeted. For the new coverage to kick in, three main conditions must be met. First, the drug’s FDA instructions must require that a healthcare professional administers or supervises the treatment. This ensures complex, high-risk medications are handled correctly. Second, a qualified home infusion therapy supplier must actually be the one administering or supervising the drug safely in the patient’s home. Third, the drug must require infusion at least 12 times a year, or the Secretary of Health and Human Services (HHS) must determine that the infusion rates are so specific that they require an external pump.

Think about a person managing a chronic condition who needs weekly or bi-weekly infusions. Instead of spending half a day traveling to and from a clinic 12+ times a year, this bill allows them to receive the same treatment at home. This isn't just about convenience; it’s about freeing up time, reducing the stress of travel, and potentially lowering the risk of hospital-acquired infections.

Where the Rubber Meets the Road: Costs and Clarity

While this expansion is a clear benefit for patient access, the bill also recognizes a crucial reality: costs. The Secretary of HHS is specifically tasked with making sure patients are clearly informed about their cost-sharing responsibilities—what they have to pay out-of-pocket—if they choose home infusion therapy. This information must be presented clearly, especially when comparing those costs to getting the same drugs in other Medicare-covered settings, like a hospital outpatient center.

This provision is important because while home care is often more convenient, it isn't always cheaper for the patient, depending on their specific Medicare plan and deductible status. If you’re a beneficiary, you need to know which option—home, clinic, or hospital—will hit your wallet the least. The bill aims to prevent sticker shock by mandating transparency before you commit to home treatment.

The Bottom Line

This legislation is a positive step toward modernizing Medicare to reflect the shift toward home-based care. It directly addresses a gap in coverage for complex infusions, making life easier for those managing chronic illnesses. The main catch? While the bill emphasizes cost transparency, the actual financial burden on the patient is still something to watch closely. Also, the HHS Secretary gets some wiggle room to decide which infusion rates require an external pump, which is a detail that could affect future coverage decisions depending on how that authority is used.