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Site of Care

Site of Care Optimization is a strategic approach aimed at ensuring that patients receive medical treatments in the most clinically appropriate and cost-effective settings. This initiative supports high-quality, patient-centered care by encouraging the use of alternative care sites—such as outpatient facilities, ambulatory surgical centers, or home infusion services—when clinically appropriate, instead of more costly settings like inpatient hospitals or hospital-based outpatient departments.

Below you’ll find resources and information to help you navigate site of care considerations, including eligibility criteria, prior authorization requirements, evidence-based best practices, and tools for discussing care options with your patients.

woman visiting doctor

Prescriber’s Quick Reference Guide

Reinsurance Drugs must be processed through the pharmacy benefit for Arizona Complete Health–Complete Care Plan and are not allowed to be billed through the medical benefit.

Alpha-1 Antitrypsin Deficiency

ARALAST NP

ZEMAIRA

GLASSIA

 

 

Autoimmune Disorders

ACTEMRA

STELARA

ENTYVIO

RENFLEXIS

INFLIXIMAB

SIMPONI ARIA

ORENCIA

SKYRIZI

 

Immune Deficiencies & Related Disorders

ASCENIV

GAMUNEX-C

BIVIGAM

HIZENTRA

CARIMUE

HYQVIA

CUVITRU

OCTAGAM

FLEBOGMMA

PANZYGA

GAMMAGARD LIQUID

PRIVIGEN

GAMMAGARD S/D

XEMBIFY

GAMMAKED

 

GAMMAPLEX

 

Iron Products

FERRLECIT

INFED

VENOFER

FERAHEME

 

Immunosuppressants

NULOJIX

 

 

Multiple Sclerosis

LEMTRADA

TYSABRI

OCREVUS

 

 

Other

PROLIA

RITUXIMAB

VYVGART

VYEPTI

 

Systemic Lupus Erythematosus

BENLYSTA

 

 

Oncology

KEYTRUDA

ADCERTIS

BLINCYTO

LEUPROLIDE

Home Infusion Services provide:

  • Convenience - In-home and AIS-based infusions are scheduled directly with patients enabling flexibility, independence and enhanced quality of life
  • Cost - Infusions may be provided at a lower cost to patients promoting compliance to therapy and ultimately improve outcomes and reduce health costs
  • Safety - Clinicians are certified and specialized in delivery of chronic and complex drug therapy and careful patient monitoring

For patient referrals or additional information, contact:

Pharmacy Provider Liaison
Phone Number: 1-888-788-4408 ext. 6031278 or Email
Monday through Friday 8:00 a.m. to 5:00 p.m.
Turn Around Time: 24 Hours

It is the policy of health plans affiliated with Centene Corporation that requests for outpatient IV or injectable therapy not meeting specified criteria should be provided in an alternate less intensive site of care. (AZ.CP.PHAR.493)

Provider Name

Services Offered

Phone Number

Fax Number

Nursing Services

Acaria

Home

800-511-5144

877-541-1503

Yes

Aleracare (formerly VascoRx)

AIS

888-209-8874

833-329-4738

Yes

Amerita

Home or AIS

520-297-1351

520-297-5760

Yes

Aspen Infusion

Home

480-739-6040

480-739-6072

Yes

Banner Home Care

Home

520-694-9180

520-694-9170

Yes

Coram

Home or AIS

480-240-3200

602-438-4559

Yes

KabaFusion, Inc

Home

877-577-4844

877-445-8821

Yes

Nufactor

Home

520-297-1351

520-297-5760

Yes

Option Care Health (formerly Critical Care Systems)

Home or AIS

844-672-4842

888-979-8904

Yes

Optum

Home or AIS

480-705-6200

844-267-6202

Yes

Orsini Pharmaceutical Services Inc

Home

847-879-9550

847-734-1822

Yes

Patient Care Infusion

Home

480-246-3975

480-246-3974

Yes

SISU Healthcare Solutions

Home

480-999-4488

480-999-6163

Yes

Soleo Health

Home or AIS

480-296-0222

480-264-0495

Yes

Frequently Asked Questions

 

Terminology

Definition

Site of Care (SOC)

The redirection of administration and/or dispensing of specialty drugs in outpatient facilities to the home, office, or AIS

Ambulatory Infusion Suite (AIS)

A standalone clinic that providers infusion therapy services to patients outside of a hospital

AZ.CP.PHAR.493

Infusion Therapy Site of Care Optimization

Policy created to review the place of service for potential Site of Care redirection. When coverage criteria are met for the injectable medication, this coverage policy is used to determine the medical necessity of the requested site of care.

 

Place of Service Name

Place of Service Code(s)

Pharmacy

01

Office

11

Home

12

Off Campus-Outpatient Hospital

19

On Campus-Outpatient Hospital

22

End-Stage Renal Disease Treatment Facility

65

 

Site of care optimization represents an opportunity to improve member satisfaction while providing safe and effective care for patients. It can reduce overall healthcare costs while maintaining patient access to vital therapies.

Examples of alternate sites of care include physician offices, ambulatory infusion suites (AIS), and home infusion.

Safety: Clinicians are certified and specialize in delivery of chronic and complex drug therapy as well as patient monitoring. Experienced nurses stay for the entire infusion to make sure your patient receives quality care.

Convenience: In-home or suite-based infusions are scheduled directly with the patient to fit their lifestyle, even on weekends, which promote independence and enhance quality of life.

Cost: Alternative Sites are more cost-effective. Compliance to treatment regimen improves outcomes and reduces overall health costs.

The Pharmacy Provider Liaison will help providers find the most convenient alternate sites of care for their patients by using the Request for Information Process and/or post-denial process to locate the closest alternative site of care.

The list of recommended drugs can be found within the SOC Clinical Policy: Infusion Therapy Site of Care Optimization AZ.CP.PHAR.493 (PDF).

***For Arizona Complete Health – Complete Care Only, reinsurance drugs are excluded from SOC. Reinsurance Drugs are required by AHCCCS to billed through the pharmacy benefit and not the medical benefit.

Prescribers should indicate the place of service on the PA form manually or on the provider web portal when submitting a request – doing so will limit the outbound calls made to the prescriber office. The Pharmacy Provider Liaison can provide details on the preferred, alternate sites of care in the nearby area.

The Pharmacy Provider Liaison can provide various alternate infusion sites to find one that best suits the patient. Alternate infusion sites are safe, increase patient convenience and comfort, and may lower treatment and overall health costs.

There is a Pharmacy Provider Liaison that will regularly monitor an email box. The team will be available to members, prescribers, servicing providers and other stakeholders directly involved in the SOC initiative.

Phone: 1-888-788-4408 ext. 6031278 or Email.

Turn Around Time: 24 Hours