CMS Announces Changes to Medicare Hospice Drug Rule

Changes to a hospice drug rule will reduce the types of medications that require prior authorization. Previous rules prohibited Medicare hospice patients from filling their Part D medications until they had confirmed that hospice providers did not cover them first. Under the new rules, patients will only be required to receive additional authorization for pain relievers, anti-nauseants, laxatives, and anti-anxiety medications.

“Medicare really tried to address our concerns quickly and effectively,” said Terry Berthelot, a senior attorney at the Center for Medicare Advocacy. “They really did a good job and even though it’s not perfect, it’s so much better.”

CMS said the rule helps the agency to avoid paying twice for the same prescriptions that seniors receive in hospice care. A HHS investigation found that in 2009, Part D prescription drug plans paid more than $33 million for medications that likely should have been covered by the hospice benefit, or Medicare Part A. Medicare beneficiaries paid an estimated $4 million in copayments as well. Policy makers had been pressuring the organization to change the rule since it was implemented in March of this year.

“Based on discussions with stakeholders, we are adjusting our rules so that beneficiaries enrolled in hospice will continue to have access to their medications while balancing recommendations by the [HHS] Inspector General meant to safeguard the Medicare program,” said Raymond Thorn Medicare spokesman .

Around the Web

Medicare Modifies Controversial Hospice Drug Rule [Kaiser Health News]