CMS changes mind on hospice drugs

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The Centers for Medicaid & Medicare Services has revised guidance on authorization of hospice drugs for those under Medicare Advantage and Part D plans, according to a new memo.

The guidance memo, released July 18, says instead of having prior authorization for all hospice drugs, it will encourage PA requirements only on analgesics, antiemetics, laxatives and anti-anxiety drugs. These categories are common among terminally ill patients.

“This action by CMS will bring marked relief to hospice patients and their providers who have been dealing with the previous policy under which all drugs processed through Part D for hospice patients were subject to prior authorization,” said Andrea Devoti, National Association for Home Care & Hospice chairman of the board of directors.

The original requirement stemmed from concern that medications were being billed incorrectly to Part D plans. Hospices received a per-diem all-inclusive rate for a beneficiary. But hospice groups balked and said the new requirements would have forced terminally ill patients to fight between hospice providers and Part D plans, or give up on receiving medication.