Look at where patients get specialty drug infusion therapy

For employers, managing the rising cost of infusion therapy is critical, as spending in this category is increasing 5% to 7% annually due to the growing prevalence of chronic conditions and completherapies.

In 2024 alone, the FDA approved 50 novel therapies, most of them specialty medications, further accelerating cost growth and shifting expectations for care delivery.

Although specialty drugs are used by less than 2% of the population, those drugs now account for around 54% of all drug benefit costs, highlighting their escalating financial impact on the health care system.

One solution is site-of-care optimization, which aims to shift employee infusion therapy from hospital-based clinics to lower-cost settings such as ambulatory infusion centers or the patient's home.

Site-of-care optimization has proven to not only alleviate financial pressures, but it also prioritizes quality care, enhances patient convenience and supports better clinical outcomes.

Why Site-of-Care Optimization Matters to Employers

Lower plan costs: Shifting infusion therapy from hospitals to home or ambulatory infusion center settings can reduce costs by up to 50%. On average, home infusion offers savings of $1,928 and $2,974 per treatment course compared to hospital-based care. Higher cost drugs offer the potential for even greater savings.

Improved employee experience: Home and ambulatory infusion center treatment is more convenient for patients, helping to reduce disruptions to daily life, ease caregiver burdens and support both mental and physical well-being. Studies show higher satisfaction with home infusions than with hospital treatments, citing increased comfort and convenience.

Enhanced clinical outcomes: Alternative settings may assist with promoting better patient adherence and enhancing care coordination. Studies have shown that outcomes with home infusion therapies are comparable to, or even better than, those achieved with hospital-based care.

Reduced hospital readmissions: Home and ambulatory infusion center treatment significantly lowers the risk for hospital-acquired nosocomial infection. According to the Journal of the American Medical Association, patients receiving home infusion therapy have a 26% lower likelihood of hospitalization compared to those treated in traditional hospital settings, reducing overall cost and promoting better outcomes.

The COVID-19 pandemic accelerated awareness and acceptance of home infusion options. Today, spending on home and alternate site infusions in the United States is .around $25 billion and growing.

Many employers are updating site-of-care optimization benefit policies to support the shift away from hospital-based infusion therapy.

What employers can do now

To maximize the benefits of site-of-care optimization, employers and their benefits advisors should review and update benefit designs to support this approach.

♦ Identify high-cost infusion claims that could benefit from a site-of-care change.

♦ Eliminate unnecessary requirements that push employees toward hospital-based infusions.

♦ Educate employees about improved outcomes and costs associated with home and ambulatory infusion center treatment.

As demand for infusion therapies increases, employers face mounting financial pressures. Site-of-care optimization delivers a win-win, by reducing costs while improving patient satisfaction, convenience and adherence.

The outcome: stronger clinical results without compromising care quality, making this an essential strategy for modern benefits programs.

Melinda Baxter, RN, MSN, CCM, is executive director of the RGA ROSE Consulting Group. Clayton Edwards, RPh, MBA, is senior vice president for payer business services at AscellaHealth.