Medicare Home Infusion Rules Get Overhaul: Bill Changes Payments, Provider Roles, and Drug Coverage Starting 2026

This bill, the "Preserving Patient Access to Home Infusion Act," significantly updates the rules for how Medicare covers infusion therapy administered at home. Effective January 1, 2026, it changes payment structures, specifies included services like pharmacy coordination, expands who can oversee care plans, and adjusts which drugs and supplies fall under these rules.

Untangling the IV Lines: What's Changing for Home Infusion?

The legislation aims to clarify and potentially stabilize home infusion services under Medicare. Key changes include:

• Pharmacy Services Included: For the first time, specific pharmacy services like drug prep, compounding, patient assessments, and care coordination are explicitly bundled into the definition of home infusion therapy services covered by Medicare (Sec 2). This could mean more integrated care, ensuring the pharmacy is officially part of the team managing your therapy.
• Payment Tweaks: Payment is clarified to apply for each day a drug is administered. From 2026 through 2030, there's a specific benchmark: payments will reflect 5 hours of infusion time for a given therapy in a day. If a qualified supplier isn't physically present during administration (like for therapies using an easy-to-manage pump), the payment drops to 50% of the full rate (Sec 2). This attempts to match payment to the level of effort involved.
• Expanded Care Planners: Nurse practitioners (NPs) and physician assistants (PAs) will be allowed to establish and review home infusion plans of care, a role previously limited to physicians (Sec 2). This could potentially speed up access to care, especially in areas where physician availability is tight.

The Drug List Shuffle: Which Meds Make the Cut?

The bill modifies the definition of a "home infusion drug" covered under these payment rules (Sec 3). It now includes drugs or biologicals given intravenously without needing a medical pump. However, there's a significant carve-out: specified non-pump drugs or biologicals are excluded. This exclusion specifically targets antibacterial, antifungal, or antiviral drugs administered intravenously without a pump.

What this means in practice: While the door might open for some non-pump IV drugs to have their associated services covered under home infusion rules, critical infection-fighting therapies delivered the same way are explicitly left out of this specific coverage definition. Patients needing certain IV antibiotics or antifungals at home without a pump might find the services surrounding their administration aren't covered under this part of Medicare, even if the drug itself is covered elsewhere.

Supplies Included: Convenience or Cost Shift?

Starting in 2026, the bill also changes how basic supplies are handled (Sec 4). Items like tubing, catheters, dressings, needles, syringes (and specific items under codes A4221, A4222, K0552) won't receive separate Medicare payment if they are provided on the same day as home infusion therapy services that are already being paid for under these new rules.

This could simplify billing by bundling costs. However, it also means suppliers won't be reimbursed separately for these essential items. The practical effect remains to be seen: will this lead to cost savings, or could it potentially impact the quality or availability of supplies provided to patients if suppliers face reduced reimbursement for these necessary components of care?