The new report, ASOC: Driving Medical Policy Changes, briefly explores the shift to alternate sites of care (ASOC), the underlying issues, and resulting implications for key stakeholders around the use of biologic and specialty infusion drugs.
Alternate Sites of Care (ASOCs) refer to healthcare that is delivered in settings different from and generally less expensive than a hospital room, outpatient center or physician’s office.
Traditionally, these have included in-home, hospital outpatient department clinics, retail or convenience care clinics, urgent care clinics, and medical clinics. Other traditional sites of care that have grown as care has shifted include ambulatory surgical centers, infusion centers, and long-term care and skilled nursing facilities. Recently, we have seen new sites of care emerge recently that include employer-managed health sites, digital health, and telemedicine.
Among the factors driving patients into ASOC are physician shortages and financial risk from insurance decisions resulting in medical policy changes. As the use of “buy and bill” as the principal reimbursement method for specialty oncology and anti-inflammatory products decreases, payers are increasingly interested in exploring alternatives to lower their costs for specialty products.
An unanticipated recent driver in the shift to ASOC is the increase in the number of COVID-19 patients seeking medical care in alternate care sites where they can receive medical care for the duration of their isolation period. These are typically established in non-traditional environments.
This report takes a brief look at the strategies and new policies of payers and PBMs as they look to lower the cost of specialty drugs and compete successfully in an evolving market and the resulting impact on key industry stakeholders.
Table of Contents
Introduction – pg. 4
Specialty Drugs Overview – pgs. 5-6
About ASOCs – pgs. 7-12
- Factors Underlying the Shift to ASOCs
- ASOCs Related to Reimbursement
Coverage Policies – pgs. 13-21
Perspective of Stakeholders in an Expanding ASOC Environment – pg. 22
References – pg. 23