Overview
The infusion market is undergoing significant change in 2026, fueled by Medicare drug price negotiation, site-of-care steering, and evolving drug acquisition models. In this webinar, we examined the evolving roles of buy-and-bill and white bagging, the continued movement of therapies from the medical to pharmacy benefit, and the increasing compliance risks associated with these developments.
Key takeaways included:
- The infusion market is being reshaped by margin pressure, site-of-care steering, and drug acquisition model changes. Medicare drug price negotiation, payor/PBM steering, and white/brown bagging are changing where infusions occur, who controls drug economics, and how providers operate.
- Providers are responding by rethinking service lines, payor contracts, revenue arrangements, and care settings. These strategies may preserve margins, but they can also create patient access challenges and require careful legal structuring.
- Fraud and abuse risk is a major gating issue for infusion arrangements. Medical directorships, administrative services arrangements, leases, physician JVs, and data deals can implicate Stark, AKS, the False Claims Act, and state analogues.
- Strong compliance infrastructure is essential as business models evolve. Providers should focus on FMV support, written policies, contract review, billing controls, monitoring/auditing, and periodic reassessment as market conditions change.