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.
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 | Yes | ||
Aleracare (formerly VascoRx) | AIS | Yes | ||
Amerita | Home or AIS | Yes | ||
Aspen Infusion | Home | Yes | ||
Banner Home Care | Home | Yes | ||
Coram | Home or AIS | Yes | ||
KabaFusion, Inc | Home | Yes | ||
Nufactor | Home | Yes | ||
Option Care Health (formerly Critical Care Systems) | Home or AIS | Yes | ||
Optum | Home or AIS | Yes | ||
Orsini Pharmaceutical Services Inc | Home | Yes | ||
Patient Care Infusion | Home | Yes | ||
SISU Healthcare Solutions | Home | Yes | ||
Soleo Health | Home or AIS | 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 |
|
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.
Yes, the SOC initiative is based on Clinical Policy: Infusion Therapy Site of Care Optimization AZ.CP.PHAR.493 (PDF).
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