WHO WE ARE
National Infusion Center Association (NICA) is a nonprofit trade association and the nation’s leading voice for non-hospital, community-based infusion providers that offer a safe, more affordable, and more cost-effective alternative to hospital care settings for provider-administered medications.
WHAT WE DO
NICA’s efforts are focused on addressing and overcoming challenges and threats to the sustainability of the most affordable care setting for provider-administered medications. Our goal is to help key decision-makers understand the value of receiving provider-administered medications in non-hospital care settings, and ensure that the community-based infusion center remains a safe, more efficient, and more cost-effective alternative to hospital care settings.
We support policies that improve drug affordability for beneficiaries, increase price transparency, reduce disparities in quality of care and safety across care settings, and enable care delivery in the highest-quality, lowest-cost care setting.
As a trade association, NICA will:
- Build relationships with key influencers and decision-makers based on the value that delivering provider-administered medications in office-based care settings brings to the health care system, patients, and payors;
- Ensure the preservation of a viable, efficient, and cost-effective non-hospital delivery channel for provider-administered medications;
- Identify, address, and overcome internal and external threats to the sustainability of non-hospital care settings for provider-administered medications;
- Protect the buy-and-bill model, ensure appropriate and sustainable reimbursement, and support infusion providers’ professional interests;
- Protect the provider-patient relationship and clinicians’ prescribing authority from harmful PBM and insurer practices;
- Develop and promote industry standards to reduce disparities in quality of care and safety to support access to consistent, high-quality medication preparations in a safe environment across all care settings;
- Promote strategies to improve treatment adherence;
- Reduce waste, unnecessary complexity, and administrative burden associated with billing and insurance-related activities; and,
- Tenaciously advocate and lobby for responsible medical benefit reform.
OUR STANCE ON IMPORTANT TOPICS
The non-hospital, community-based infusion delivery channel represents the most economical care setting for provider-administered medications. Ensuring that these care settings remain economically viable to meet the demands of today’s market, as well as tomorrow’s, will be critical to reducing burden, cost, and wasteful consumption within our healthcare system.
NICA will SUPPORT measures to make it easier for the most economical care setting to accommodate existing patient demand, and measures to allow for market expansion to build the capacity required to accommodate the patient demand of tomorrow.
NICA will OPPOSE changes that would make it harder for providers to treat existing patients and/or expand to treat additional patient populations.
The delivery channel’s capacity largely relies on the buy-and-bill model to support the community-based infusion care model. The delivery channel does not have the capacity to meet tomorrow’s demands as the R&D pipeline grows richer with complex provider-administered medication formulations. Patients have waited long enough for these innovative therapies and the hope they bring; they cannot afford to lose access to the lowest cost site of care option, nor should they have to. Protecting and preserving the buy-and-bill model is critical for the future of chronic disease management, population health, and a sustainable health care system.
NICA will SUPPORT provider choice and autonomy to acquire drugs using the model most conducive to effective and efficient patient care coordination.
NICA will OPPOSE specialty pharmacy mandates and other broad models that reduce efficiency, limit provider choice, increase administrative burden, increase cost, and/or add waste.
Maintaining viable economics in lower cost alternatives to hospital-affiliated care settings is critical in improving the affordability and accessibility of provider-administered medications. The current reimbursement environment is volatile with increasingly pressurized atmosphere to reduce medical benefit drug spend, reduce or remove drug payments, and reduce reimbursement for professional services. The infusion care model economics, particularly professional service reimbursement, must keep pace with inflation to cover practice expenses.
NICA will SUPPORT:
- Responsible (net positive) reimbursement;
- Reimbursement of professional services at high-level CPT codes;
- Supplementary payment models (e.g., physician office facility fee, monthly patient management fee) to keep providers whole.
NICA will OPPOSE policies that will result in reductions in net reimbursement.
Treatment adherence is a significant factor influencing increased health spend through sub-optimal disease management, particularly among our nation’s sickest and most vulnerable patients managing complex, chronic diseases—like autoimmune conditions—resulting in poor health outcomes, reduced quality of life, and increased physical, emotional, and economic burden of disease.
NICA members strive to deliver the safe, high-quality infusion care their patients deserve. To that end, NICA is proud to have published the industry’s first standards of care for office-based infusion, and continues to develop resources to support providers’ efforts to meet those standards and achieve clinical excellence.
NICA has been the nation’s voice for infusion access since 2010, overcoming countless barriers to care, access obstacles, and threats to our nation’s non-hospital, community-based delivery channel for provider-administered medications. The NICA team single-handedly reversed several immediate threats that would have carried profound economic implications and significantly reduced access to care. From short-funding J-codes in drug payments, to down-coding professional service payments, to removing restrictions on weight-based doses, to reversing proposed reimbursement reform. NICA has eliminated numerous threats that would have devastated our community-based infusion delivery channel before these threats were realized. Through our efforts, NICA has helped hundreds of thousands of patients optimize health outcomes and quality of life through effective and responsible disease management.
No other organization can boast such commitment and an extensive track record of success within the provider-administered medication market. As a trade association, NICA will bring our long history of dedication, tenacity, and success to be the voice for the nation’s non-hospital, community-based infusion providers and their professional interests.