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Antifungals/antivirals

Acyclovir, foscarnet, amphotericin B and ganciclovir is covered for administration in the home by Medicare when one of the following sets of criteria is met:

Criteria set 1
1. Parenteral infusion in the home is reasonable and necessary.
2. An infusion pump is necessary to safely administer the drug.
3. The drug is administered by a prolonged infusion of at least 8 hours because of proven improved clinical efficacy.
4. The therapeutic regimen is proven or generally accepted to have significant advantages over intermittent bolus administration regimes or infusions lasting less than 8 hours.

Criteria set 2
1. Parenteral administration of the drug in the home is reasonable and necessary.
2. An infusion pump is necessary to safely administer the drug.
3. The drug is administered by intermittent infusion (each episode of infusion lasting less than 8 hours) which does not require the patient to return to the physician's office prior to the beginning of each infusion.
4. Systemic toxicity or adverse effects of the drug is unavoidable without infusing it at a strictly controlled rate as indicated in the Physicians Desk Reference, American Medical Associations drug Evaluations, or the U.S. Pharmacopeia Drug Information.

Liposomal amphotericin B is covered for patients who meet one of the above sets of criteria as well as one of the following criteria:

1. The patient has suffered some significant toxicity that would preclude the use of standard amphotericin B and is unable to complete the course of therapy without the liposomal form, or
2. The patient has significantly impaired hepatic function.

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