An Unintended Consequence of the 21st-Century Cures Act for Patients With Heart Failure
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Most of the discussion after the passage of the 21st-Century Cures Act has focused on the law’s increased funding for biomedical research and its more controversial changes to drug and device approval. Little attention has been paid to the legislation’s changes to reimbursement for home infusion drugs. However, this less publicized aspect may ultimately limit patient access to home inotropic infusions, which are associated with decreased hospital admissions, lengths of hospital stay, and total spending for patients with advanced heart failure.1
The epidemiology of heart failure is changing and with it the epidemiology of home inotrope use. Patients are living longer with heart failure, now often not requiring advanced therapies, until they have become medically ineligible for ventricular assist devices or transplantation. At the same time, hospitals are facing increasing pressure to decrease lengths of stay and readmission rates. Home inotropic infusions can offer a practical solution to both challenges. As a result, the recent diffusion of home inotropic drugs, which include dobutamine or milrinone, has increased. Between 2010 and 2014, a 63% increase occurred in the number of beneficiaries receiving home milrinone and a 44% increase in the number receiving home dobutamine. As a result, in 2014, Medicare spent $243 million ($64 152 per beneficiary on average) for home milrinone, an increase of 55% …