Medicare to Allow Home Infusions for Benlysta, Other Medications

UPDATE: On May 8, the Lupus Foundation of America submitted comments on CMS' interim final rule commending the agency for taking swift action to ensure continuity of care for people with lupus amid the coronavirus pandemic. The comments also urge CMS to implement the rule in a way that reduces administrative burden for providers while managing out-of-pocket expenses for people with lupus and other conditions. Click here to read our complete comments.

On March 30, 2020, the Centers for Medicare & Medicaid Services (CMS) announced new regulations that will affect people with lupus who are on Medicare and take Benlysta. For the first time, people with lupus on Medicare will be able to receive infusions of Benlysta at home and will not be required to go to a physician’s office or other facility to get their infusions. The Lupus Foundation of America began advocating for this change earlier in March as the coronavirus spread globally and the federal government and states began instituting social distancing guidelines and limiting travel.  Our goals are to make sure that people with lupus not only have uninterrupted access to their medications, but also to limit their potential exposure to the coronavirus.

The new rules are retroactive and took effect March 1. They do not require home infusions, but give patients that option if they and their physician agree it is safe and medically appropriate. The Foundation is currently analyzing the details of the rule. We are working with the medical community and CMS to ensure the option for home infusions will be easy to implement and will  meet the needs of people with lupus and their physicians. People with lupus on Medicare who are interested in obtaining infusions in their homes should speak with their physicians to determine whether it is an appropriate option for them. Note that the option to obtain a home infusion is being offered due to the coronavirus and is temporary.