Drug reimbursement on home hemo different than conventional hemo?

[swramsay]

While I was browsing around, I saw a short thread about not getting prescriptiion reimbursement because the person was on home dialysis. Can that be a reason for an insurance company to not pay for meds? I can't imagine why but has that been home dialysis patients experiences on this site?

[petey]

We have seen NO changes in Marvin's drug benefits since he's been on home hemo (18 months now).

[jbeany]

Some things get a bit more complicated on home hemo - Nxstage isn't set up for drug dosing while you are on a run.  It's possible, but it's sort of an "off-label" use of the machine.  It makes things that are normally dosed thru the machine harder to get.  My insurance will not pay for iron to be given thru home hemo.  If I need iron, I have to go to the infusion center and get it all at once, instead of in small doses over several days like they do in-center.  (And some insurance companies won't let you get a large dose, either, so you have to keep going back repeatedly.)  Things like Aranesp and Hectorol also require some juggling to work out, since the billing is different if you aren't receiving it in-center.

[Bill Peckham]

Generally any injectable medication (except Epo) is an issue with Medicare reimbursement at home. You might have seen people talking about not being able to give themselves iron at home. The iron is covered but has to be administered incenter. This may be changing (should change) once the expanded bundle comes into effect but for now if you're at home you'll get your iron during clinic visits and if you need activated vitamin D you'll take a pill.