Home infusion
Blue Shield of California offers access to home infusion for members prescribed infusion therapy medications. Blue Shield has partnered with ASPN Pharmacies (ASPN) to help members access home infusion services. Home infusion is available for all lines of business, but services through ASPN are only available for members living in California, enrolled in Commercial HMO and PPO plans.
Overview
Infusion therapy is when a nurse or doctor administers prescribed medication through a needle or catheter. If you are currently receiving infusion therapy at a hospital outpatient facility or a doctor’s or other provider’s office, you may be able to receive your treatments at home instead. Home infusion gives you the convenience of having your medication infused or injected safely in the comfort of your home, on your own schedule, as prescribed by your doctor. Your infusion treatment will always be performed by a registered nurse and may even result in a lower out-of-pocket cost.
A variety of infusion therapies can be delivered at home. These include, but are not limited to:
- Hydration
- Factor products
- Biologics
- Pain management
- Injectable medications
- Immunoglobulins
- Anti-infectives (antibiotics, antivirals, antifungals)
Benefits
Lower out-of-pocket costs
There are tangible costs associated with travel to doctors’ offices and hospital outpatient facilities, such as taking time off work or school and paying for transportation or parking. By having nurses come to your home instead, you will save on travel time and cost to and from your doctor’s office or hospital outpatient facility.
You may also have a lower out-of-pocket cost with home infusion. Outpatient hospital drug administration often costs two to three times more than at home or in a doctor’s office. By switching to a lower-cost site of care, you may also have a lower out-of-pocket cost. Some Blue Shield member plans have a flat dollar copay or home infusion instead of a coinsurance, making your out-of-pocket costs more predictable. See below for an example.
Example*
| Place of service | Cost per infusion drug | Coinsurance or copayment | Indirect costs per visit** | Member pays |
|---|---|---|---|---|
| Outpatient facility | $15,000 | 10% coinsurance | Various | $1,500+ |
| Home infusion | $6,000 | $45 copay | $0 | $45 |
| Example member savings with home infusion = $1,455+ | ||||
*This example may not reflect your current benefit design, medication, or dosage. Please refer to your Evidence of Coverage (EOC) or Certificate of Insurance to determine your out-of-pocket costs for medication administration at a hospital outpatient facility or at your home using a home infusion provider.
**Indirect costs could include:
- Cost of gas to travel to doctor’s office or hospital
- Parking cost at doctor’s office or hospital
- Occupational cost of missing work or school due to schedule
- Childcare costs
Convenience and flexibility
Home infusion providers have nurses that cover times during the day, and also nights and weekends. Rather than fitting your busy schedule around when the doctor or hospital outpatient facility’s next available appointment is, home infusion allows you to schedule infusions at the most convenient time for you. This means that you don’t have to take time out of your day and adjust your schedule to accommodate normal office hours to receive your infusion. You can conveniently schedule the infusion when you want it.
Safety with a trained nurse
Home infusion nurses are specifically trained to provide the services required during your visit, from counseling you on the infusion to administering your infusion and communicating with your doctor about your therapy.
The nurse will be there with you during your first infusion, monitoring your progress throughout. Depending on your condition, medication regimen, and comfort level, some members may find freedom in being able to administer their own medications. Depending on your treatment, regimen nurses may stay throughout the infusion process.
Who is ASPN Pharmacies?
Blue Shield has partnered with ASPN to help members and doctors identify in-network home infusion providers who are nearby and can service your infusion needs. Once you and your doctor decide that home infusion meets your treatment goals, your doctor can send home infusion orders to ASPN. ASPN will coordinate with an in-network home infusion provider. You will then receive a call from the home infusion provider to set up your appointments.
You and your doctor are not required to use ASPN’s services and are welcome to use any in-network home infusion provider.
Interested in home infusion?
Talk to your doctor to see if home infusion is right for you and your treatment goals. If so, your doctor will work to ensure any authorizations, if needed, are in place or updated to reflect this change to home infusion. Once an authorization is approved, you will receive a call from ASPN, or your selected home infusion provider, to coordinate your home infusion appointment.
You are welcome to end home infusion services at any time if you decide it is not right for you. Just contact your home infusion provider to cancel all future infusion appointments. Make sure to talk to your doctor about switching back to the office or outpatient hospital infusion.
Learn more about whether home infusion is right for you in this flyer:
