Site of Care Cost Comparison
| Setting | Relative Cost | Examples |
|---|---|---|
| Hospital outpatient | 100% (baseline) | Hospital infusion center |
| Physician office | 50–60% | Oncologist office, rheumatologist office |
| Independent infusion center | 40–50% | BioScrip, Option Care |
| Home infusion | 30–40% | Coram, BioScrip home |
| Specialty pharmacy (self-administered) | 30–40% | Mail order specialty pharmacy |
Site of Care Steerage
Site of care steerage directs members to lower-cost settings for specialty drug administration. Common steerage mechanisms: (1) cost-sharing differentials — lower cost-sharing at preferred settings; (2) prior authorization — require clinical review for hospital outpatient administration; (3) care navigation — help members find lower-cost settings; and (4) physician outreach — educate physicians about lower-cost administration options.
Home Infusion
IQ Insight
Home infusion — administering specialty drugs at home by a trained nurse — is the lowest-cost setting for appropriate specialty drugs. Home infusion is safe and effective for many specialty drugs, including biologics for rheumatoid arthritis, multiple sclerosis drugs, and certain oncology drugs. Home infusion programs can save 40–60% vs. hospital outpatient administration.