Opinion
Video
Training Nurses for Subcutaneous Delivery
Panelists discuss how switching from intravenous (IV) to subcutaneous (SubQ) therapies requires proactive management of reimbursement, authorizations, and clinical workflows—emphasizing early payer coordination, billing oversight, and nurse retraining to ensure both financial sustainability and safe, efficient patient care.
Switching patients from IV to SubQ therapies introduces a host of reimbursement and administrative challenges that must be addressed early in the treatment planning process. A key issue is the need for new authorizations when transitioning formulations, particularly when therapies begin with IV and transition to SubQ in maintenance phases. Practices should anticipate these requirements and initiate dual authorizations up front when possible. This reduces delays in care and minimizes last-minute complications for both patients and administrative staff. Coordination between clinical teams and authorization departments is critical, especially when the therapy is newer or not yet widely recognized in national guidelines.
In addition to payer requirements, close monitoring of reimbursement patterns is essential when introducing new SubQ products. Practices benefit from flagging patients who begin on emerging formulations to ensure that billing teams are actively tracking payment outcomes and identifying potential issues early. Contracting with manufacturers can also be a strategic step to offset reimbursement variability and ensure financial viability. This level of coordination—between clinicians, billing, and financial teams—ensures that operational decisions are guided not only by clinical benefit but also by economic sustainability and payer alignment.
On the clinical side, implementing SubQ therapies has led to the need for nursing workflow adjustments and retraining. One practical challenge has been the physical strain on nurses manually administering multiple injections. This prompted some centers to shift from straight needles to butterfly setups and train staff to use larger syringes with palm pressure for better ergonomics. Investing in ongoing hands-on training, annual competencies, and mentorship from experienced nurses can ease the transition and prevent staff injury. As doses and volumes increase, practices are also exploring syringe pumps to further improve administration efficiency and safety, underscoring the importance of continuously evolving both policy and practice.
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