Chemotherapy
Administration of any chemotherapeutic agent via external infusion pump is covered in the home for the treatment of primary hepatocellular carcinoma or colorectal cancer where the disease is unresectable or where the patient refuses surgical excision of the tumor.
Other diagnosis covered when one of the following: bleomycin sulfate, cladribine, cytarabine, doxorubicin HCL, Fluorouracil, floxuridine, vinblastine sulfate, vincristine sulfate is administered continuous over at least 8 hours via external infusion pump when the regimen is proven or generally accepted to have significant advantages over intermittent administration regimens and either of the following criteria set are met:
-
Criteria set 1
- Parenteral infusion in the home is reasonable and necessary.
- An infusion pump is necessary to safely administer the drug.
- The drug is administered by a prolonged infusion of at least 8 hours because of proven improved clinical efficacy.
- 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
- Parenteral administration of the drug in the home is reasonable and necessary.
- An infusion pump is necessary to safely administer the drug.
- 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.
- 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.