NICA Legislative & Policy Update: Protecting Access to Infusion Care
The National Infusion Center Association (NICA) continues to advocate at both the state and federal levels to protect non-hospital, community-based infusion center viability and ensure patient access to life-saving infusion therapies. Key areas of focus include:
Opposing government price-setting policies that threaten provider sustainability: NICA is actively pushing back against Prescription Drug Affordability Boards (PDABs), Upper Payment Limits (UPLs), and other price-setting proposals that risk reimbursing providers below acquisition cost. These policies jeopardize the buy-and-bill model and could limit patient access to community-based infusion care.
Protecting Medicare reimbursement for Part B infused therapies: NICA is advocating for reforms to the Medicare Drug Price Negotiation Program, including support for the Protecting Patient Access to Cancer and Complex Therapies Act (PACTA). Without fixes, current policies risk incorporating government-set prices into reimbursement calculations, potentially forcing providers to absorb losses or reduce services.
Monitoring Most Favored Nation (MFN) and international reference pricing proposals: NICA is closely evaluating federal proposals, including MFN-style approaches and CMMI demonstration models, that would link Medicare Part B drug reimbursement to international pricing benchmarks. While CMS has preserved ASP-based reimbursement and excluded reference biologics and biosimilars from certain models, NICA remains cautious about potential downstream impacts, including increased white bagging, changes in payer behavior, and unintended consequences for beneficiaries. NICA continues to engage with policymakers to ensure these policies protect provider viability, preserve site-of-care choice, and maintain patient access to essential infusion therapies.
Addressing healthcare consolidation and 340B-driven market distortions: NICA is raising concerns about how unchecked consolidation and expansion of the 340B Drug Pricing Program can disadvantage independent infusion providers, reduce competition, and ultimately limit site-of-care options for patients. Advocacy efforts emphasize transparency and reforms that protect access to community-based care.
Fighting harmful payer and PBM practices: NICA is actively opposing utilization management barriers such as white bagging, restrictive formularies, step therapy, non-medical switching, and PBM practices that interfere with clinical decision-making. These policies can delay care, increase patient risk, and undermine provider autonomy.
Driving state-level policy wins that improve access and affordability: Through grassroots advocacy, testimony, and direct engagement with lawmakers, NICA has helped advance PBM reform, step therapy protections, prior authorization improvements, and “All Copays Count” policies in multiple states, while stopping harmful legislation (PDABs and UPLs) before it could impact providers or patients.
Together, these efforts reflect NICA’s ongoing commitment to protecting infusion providers, preserving patient choice, and ensuring access to safe, community-based infusion care nationwide.
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NICA Sets the Standards
The NICA Standards of Excellence for Ambulatory Infusion Centers are ANSI-accredited American National Standards, developed by the industry for the industry. These Standards establish best practices for safe, consistent, and high-quality infusion care.
The NICA Standards are available for purchase in digital and printed formats. Elite Members of NICA receive complimentary access to the digital version as part of their membership and Supporting members receive a 30% discount.
👉 Purchase the Standards or learn more here:
https://infusioncenter.org/resources/nica-standards/
NICA is currently underway with its rescheduled Standards revision cycle, using a transparent, consensus-based process that includes opportunities for public comment. To be notified when draft Standards are released for public review—and when new editions are published—sign up for NICA newsletters here.
