Private infusion centers present new options for chronic illnesses

Dec. 3 (UPI) -- Privately owned, standalone infusion centers are increasingly providing a comfortable and convenient alternative to hospitals and doctors' offices for people on prescribed medications for chronic diseases administered via infusion, experts told UPI.

However, despite the recent growth of infusion-based medications for disorders that range from Crohn's disease and ulcerative colitis to migraine and Alzheimer's disease, infusion services, depending on the location where they're provided, may not be covered by insurance, they said.

In addition, not all infusion centers have the necessary expertise in-house to safely deliver medications and deal with any potential side effects or complications.

"The advantage many of these private centers offer is convenience," Kavita V. Nair, a professor of neurology and pharmacy at the University of Colorado Anschutz Medical Campus, told UPI in a Zoom interview.

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"If you have a chronic disease that requires infusion therapy, you can go someplace close to you, and that place may be open at night and on weekends, unlike a hospital infusion center," she said.

Freestanding businesses

Standalone, or ambulatory, infusion centers are freestanding businesses, suites in pharmacies and other outpatient settings in which patients receive prescription medications, according to the National Infusion Center Association, a trade association and accrediting body that represents these facilities.

Many are housed in storefront locations, in retail centers or shopping malls, Nair said.

Once largely the domain of hospital-based and doctors' offices, the facilities these services provide typically focus on the preparation and administration of biologic therapies for conditions such as Crohn's disease and ulcerative colitis, as well as rheumatoid arthritis, multiple sclerosis and migraines.

Collectively, more than 40 million people in the United States have been diagnosed with these diseases, the Centers for Disease Control and Prevention estimates.

An emerging market for infusion centers has been the treatment of Alzheimer's disease, a condition that could impact up to 15 million people nationally by 2030, said Nair, who specializes in pharmaceutical therapy for neurological disorders.

Two infusion-based therapies designed to slow the progression of Alzheimer's have been approved by the Food and Drug Administration in recent years, she said.

More than 800 standalone infusion centers exist across the United States, many of them part of large corporate chains, according to industry reports.

Collectively, these locations administer about 5% of all infusion-based medicines nationally, the National Infusion Center Association estimates, with hospitals still administering the bulk of them.

However, this percentage is expected to grow before the end of the decade, it says, particularly as more infusion-based medications are brought to market.

In all, more than 550 infusion-based therapies have been approved by the FDA to treat a variety of diseases, with more than 250 others in the pipeline, according to the association.

"So many of the new therapies coming out for conditions such as multiple sclerosis and Alzheimer's disease are infusions, and these are chronic diseases, requiring as many as two infusions per month," Nair said.

"With the patient volume, and the number of infusions needed, there is definitely business there for standalone centers -- and these are very lucrative drugs," she said.

In Colorado, Nair said she knows of 25 privately owned, standalone infusion centers, up from three in 2019.

Infusion information

One reason for the proliferation of private, ambulatory infusion centers across the country has to do with cost, according to Nair.

Infusion is expensive -- at a large, academic medical center, the service may cost up to $5,000 per treatment, depending on the drug being used, research suggests.

At hospitals, this cost often includes "facility fees," which are surcharges billed to patients, and their insurance providers, to cover expenses related to staffing and the operation of the facilities themselves, Nair said.

Private, ambulatory infusion centers may charge a fraction of that -- as low as one-fifth of the billed amount -- because they have lower overhead costs, she said.

"These non-hospital infusion centers really rose as a result of commercial payors saying, 'We're not going to pay for infusions in traditional hospitals,'" Nair said.

"In general, standalone infusion centers are easy to construct," she added -- because they don't have to be built within an existing hospital.

Although they vary by center, infusion rooms can be open bays with multiple reclining chairs and partial privacy walls or private rooms with beds.

That said, not all insurers are willing to pay for the full cost of infusion, and may not cover the service at privately owned centers if they don't meet certain requirements, according to Shaya Fogel, COO of Noble Infusion, which operates three infusion centers in Florida.

Most centers accredited by the National Infusion Center Association, including his, are able to work with patients' insurers to get services covered, he said.

To receive accreditation, centers have to meet certain, specific standards for the storing and preparation of medications, the cleanliness of the facility and the expertise of the staff, which ideally should include nurses, pharmacists and even consulting physicians, among other criteria.

Unique benefits

Fogel opened Noble Infusion, which is a National Infusion Center Association-accredited center, in July 2024.

All of its patients receive medications intravenously or via injection as prescribed by their physicians.

"Even though there are places offering hydration services and other things, we don't want to mix it," Fogel told UPI in a phone interview.

"Our place is there for people with chronic illness and we depend on [prescription] orders written by specialists," he said.

Much of their work includes denosumab injections for osteoporosis, ocrelizumab for multiple sclerosis and infliximab for Crohn's disease, ulcerative colitis, rheumatoid arthritis and psoriatic arthritis, Fogel said.

The centers also work with intravenous immunoglobulin therapy for these and other autoimmune diseases and increasingly donanemab and lecanemab for Alzheimer's disease, he said.

Most of its patients receive monthly infusions, although that depends on the dosing schedule for the medication, he said.

"The hospital was everybody's answer for infusion until now, but a lot of patients just won't go to a hospital," Fogel said.

Well-run infusion centers offer a level of comfort and convenience not found at most hospital-based facilities, he said.

"We offer a calm, personal and professional environment, with locations that are easy to get to, with parking," he said. "Our nurses try to establish relationships with patients."

Patients with chronic illnesses considering looking beyond the hospital for infusion services should discuss their options with their doctor and ask for recommendations, according to Fogel.

They should also ensure that any infusion center they work with is staffed by qualified nurses trained in infusion, he said.

"Good infusion centers are advocates for their patients and fight on their behalf" to make sure their services are covered by insurance, whether that's with commercial payors or Medicare and Medicaid," Fogel said.

"Do your research and don't assume hospital is only option," he said.