The first outpatient infusion centers started over 30 years ago in oncology clinics because of the intravenous delivery needed for chemotherapy drugs. In the past decade, a number of outpatient infusion clinics that deliver a wide range of drugs have sprung up, driven by growth in biologics, most of which are delivered via infusion.
"Some of the earliest biologics were approved for gastrointestinal conditions like Crohn's Disease and Ulcerative Colitis," said David Bush, RPh, owner/manager of AccuRX Infusion Center.
Since then, the conditions that are treated by infusion of biologics have expanded. "We now have 35 biologics on our formulary," said Joseph Williams, the CEO of Birmingham ID & Infusion. "We treat a number of conditions, including Inflammatory Bowel Disease, Rheumatoid Arthritis, Multiple Sclerosis, Psoriasis, Psoriatic Arthritis, Lupus, ALS, and Migraines."
Biologics, which are isolated from living sources and are more target-specific than chemically derived drugs, are the wave of the future. "I think we're just starting to see the beginning of it," Bush said. "There are two biologics now in the pipeline for Alzheimer's. Aducanumab is under FDA review and Donanemab just finished Stage 2 trials. If either of these are approved, the infusion market will explode. There is very little excess infusion center capacity right now, so as these and other drugs come out, existing centers will need to expand or new centers will have to open."
Indeed, Birmingham-area outpatient infusion centers are already seeing fast growth. "Birmingham ID & Infusion has gone from 25 outside infusion referrals in 2018 to 450 patients now," Williams said. "We just moved into our new infusion center last month and we are renovating our existing site."
With such a rapidly expanding market, why don't specialists build infusion facilities within their clinics? "There are several reasons many don't do that," Bush said. "First, biologics are very expensive. For example, the Multiple Sclerosis drug costs the provider around $40,000 for one treatment. And the complete course for the new biologic for thyroid eye disease is in the neighborhood of $250,000 a year. So it's a big investment, and with only a 10 to 15 percent profit margin, you can mess up the paperwork on one patient and not
get paid, costing you all the profit on your whole program."
Williams said, "a medical practice would need to dedicate staff to work through the pre-authorization process and the insurance benefits, to order drugs and get everything in place, while making sure patients know their deductibles and co-pays. We have a team that manages and tracks all of this."
While the costs and paperwork can fall within the economics of a large practice, it usually makes more sense for many smaller and mid-size practices to refer patients. Before freestanding outpatient infusion centers entered the market, most practices referred to hospitals. However, that has been changing due to a number of factors, starting with costs. A 2017 report by Magellan Rx Management found that the same medication, administered with the same method, is over twice as expensive in the hospital setting compared to outpatient sites. It cost $10,995 to administer Remicade in the hospital versus $4,691 in outpatient clinics. As a result, health insurers have increasingly created programs to move patients from hospitals to outpatient providers with BlueCross BlueShield of Michigan and Priority Health going so far as to eliminate most hospital infusion services from coverage.
In addition to the cost advantage, outpatient infusion clinics offer greater convenience. Patients can drive up to the retail location rather than maneuver hospital parking decks and they don't have to go through the hospital admissions process for a 45-minute infusion. Both AccuRX and Birmingham ID & Infusion have free WIFI, refreshments and TV for patients. In addition to their open area, Birmingham ID & Infusion has two private suites that include an infusion chair for pediatric patients with a seating area for parents.
"We've found that it's a great model of care," Williams said. "We are able to save payors and patients money with a smoother process for referring physicians, along with a convenient, nice environment for patients. What's not to like?"