On November 17, 2015, OptumRx, a major Pharmacy Benefit Manager (PBM) owned by UnitedHealth Group, announced its purchase of a home infusion services provider, giving the PBM a window into the home infusion market. OptumRx will now provide its aging subscriber population with access to new and additional medications and enhance its ability to deliver care to patients requiring at-home infusions. This is a clear compliment to OptumRx’s existing and growing mail order pharmacy services. AxcelaCare Health Solutions (Axcelacare), the home infusion services provider purchased by OptumRx, offers both chronic long-term therapy, such as IVIg, and acute infusion therapies, including antibiotics and parenteral nutrition, among others. With its acquisition, OptumRx has become the first PBM to enter into the home infusion specialty of services. Other PBMs are likely to follow.
Home infusion services are provided by a variety of organizations, including specialized infusion companies and pharmacies, in an effort to provide patients with complex clinical conditions with enhanced care in non-inpatient settings. Home infusion pharmacies generally compound patient specific medications and provide in-home services across state lines. According to the American Society of Health-System Pharmacists (ASHP), home infusion pharmacies tend to provide one or more of several service lines, including infusion therapies (e.g., intravenous, subcutaneous, intrathecal, epidural), specialty pharmacy services, ambulatory infusion center services, home health nursing, private duty nursing, respiratory equipment and clinical respiratory services, hospice services, home medical equipment and supplies (with or without oxygen service), and/or enteral products and supplies. According to Mark Thierer, CEO of OptumRx, by coming together with a home infusion provider such as AxcelaCare, OptumRx seeks to “more effectively support the growing number of people managing complex conditions, many of whom require infusions that increasingly involve higher-cost specialty medications.”
Independently owned home infusion pharmacy providers should take note of OptumRx’s venture into the home infusion space. Other PBMs are likely to follow the trend, creating increased scrutiny by PBMs of the independent pharmacies in their networks. PBMs often terminate independent pharmacies for pre-textual reasons when they compete to provide pharmacy benefits seen as valuable to the PBMs. Network terminations of current home infusion pharmacies are likely on the horizon.
