NICA’s Accomplishments and Future Challenges
The cost of many intravenous and injectable drugs continues to rise in the U.S., with dire consequences for patients with autoimmune diseases and their providers who constantly wonder which medications they can still afford.
Volatility in the provider-administered IV/injectable drug reimbursement landscape is one of the principal reasons the National Infusion Center Association (NICA) exists today.
For those unfamiliar with the group, NICA is a non-profit patient advocacy organization formed to improve access to provider-administered IV and injectable medications for non-oncology indications in non-hospital care settings.
In an interview with Healio Rheumatology, Brian Nyquist, MPH, executive director of the organization, stated, “NICA was formed to defragment these advocacy efforts, provide a cohesive advocacy voice for patients and their providers, and drive cross-specialty collaborative momentum behind a common goal: improve patients’ access to their prescribed provider-administered medications.”
During the interview, Nyquist pointed out some of the challenges providers face today.
“Providers are operating in an increasingly pressurized atmosphere with expectations to treat more patients with higher quality care, producing better health outcomes for reduced — and in some cases, negative — reimbursement.”
As Nyquist pointed out, as more legislators and insurers approach medical benefit reform through this lens, significant challenges will arise that will disrupt and cripple office-based infusion services that vulnerable groups rely on.
Before NICA onto the scene, specialty practices that offer in-office injectable medications in fields such as rheumatology, gastroenterology, pulmonology, allergy, and neurology were all working separately on similar issues, often duplicating efforts with poor results.
NICA’s humble beginnings date back to 2010. At the time, it operated as a virtual organization on a part-time and volunteer basis by the founders. It wasn’t until 2015, when Nyquist came on board, that the non-profit started expanding.
According to Nyquist, by the end of 2015, the group had a full-time team building and driving the organization’s full-time advocacy capabilities on a national level. Less than five years later, NICA hosted the first conference dedicated to preserving, optimizing, and expanding access to provider-administered medications.
As per Nyquist, the organization’s advocacy efforts initially centered around helping patients overcome the obstacles and barriers that restricted, delayed, or disrupted their progression from prescription to the infusion or injection chair. Today, the organization provides additional programs to meet the patients and their providers, including an education and resources program.
Programs such as “Infusion 101,” “Biologics 101,” and “How to Prepare for Infusion Day” help educate patients. Additionally, the NICA Infusion Center Locator tool makes it easier to locate the more than 3.600 infusion centers operating in the U.S. and Puerto Rico.
But perhaps the most significant accomplishment of NICA to date, according to Nyquist, stems from the intense human connection.
“We never tire of hearing that NICA’s efforts enabled a patient to play with their kids again, avoid a wheelchair, or continue using their hands. These have been incredible motivators for my team and me.”
Dollars and Sense
In 2016, NICA was quick to engage and organize a grassroots advocacy platform through which stakeholders could amplify their voice into a cohesive and collective voice in response to CMS’ proposed Part B Payment Demonstration that would change the drug payment rate to 2.5% of Average Sales Price plus a flat fee of $16.80.
“Through this effort, over 40,000 letters were sent through the platform in the first three weeks, 15,000 of which occurred within 3 hours on the day of peak engagement before the Sergeant of Arms for the Senate shut down the line of communication onto [Capitol] Hill,” Nyquist said.
Other notable accomplishments include overturning two Recovery Audit Contractor audits, as well as overturning payer policies involving weight-based dosage restrictions, short-funding J-codes, down-coding CPT codes for administration services, and mandated acquisition of drugs through a specialty pharmacy, according to Nyquist.
What the Future Holds
Nyquist anticipates that 2021 and beyond will continue to present challenges in terms of medical benefits, both for sustainability and access to care.
Among the most pressing challenges, Nyquist said, “In the Part B market, proposed reform could push the delivery channel away from buy-and-bill to a private-sector vendor distribution model similar to a mandated acquisition of drugs through specialty pharmacies.”
He also mentioned that the rise of pharmacy benefit managers and a shifting coverage and reimbursement landscape could make IV and injectable drugs less affordable and less accessible.
“Unfortunately, we have reached a point where a public charity is not enough to preserve, optimize and expand access to provider-administered medications,” he said. “As such, I am in the process of standing up a trade association dedicated to identifying, addressing and overcoming threats to the sustainability of non-hospital, office-based outpatient delivery of provider-administered medications in an effort to ensure that we have a delivery channel that cannot only meet the demand of today but the future demand of tomorrow. This is particularly important as we continue to see new drugs come to market for undertreated and infusion-naïve indications.”
“What remains clear, however, is the shift in medication technology away from small molecule, systemic-acting therapies to larger molecule, more targeted therapies like therapeutic biologic products,” Nyquist said. “The NICA team will remain tenaciously passionate and focused on ensuring that patients who are prescribed these products will be able to find a care setting, start therapy and stay on therapy until their prescriber — not their payer — determines that a different therapy may be indicated.”
Get Involved
Altus Biologics is proud to support NICA’s efforts, and we urge rheumatologists and other specialty practices to visit NICA’s website to find ways to get involved.
We recommend visiting the Infusion Confusion Forum, which provides vital educational material regarding clinicians’ in-office infusion services. Additionally, as Nyquist mentioned in his interview, physicians can take advantage of NICA’s Late-Stage Quarterly Pipeline Reports to stay abreast of potential treatment options in phase 3 or later clinical trials. Doctors can also use the legislative tracking center to help them understand state and federal legislation that NICA follows and quickly engage in grassroots advocacy.
