CMS Policy Hurting Hospice Patients & Families
A hospice patient in Oklahoma City is being denied his
medications to treat his COPD, while coping with a diagnosis and treatment for
tongue cancer. In Cadillac, Michigan a patient struggling with colon
cancer is being denied insulin to treat his diabetes and is in danger of
Due to a recent and poorly thought out Medicare Part D Prescription Drug policy, dying patients
are revoking hospice services to maintain access to other necessary
prescriptions for diseases unrelated to their terminal illness that Part D paid
for until recently.
Patients’ families are left at the pharmacy counter with no refill of
medications, after the pharmacist announces that because the patient is on hospice,
the pharmacy is no longer allowed to fill their prescriptions – which in not
Or, they are going days and sometimes weeks without the necessary
medication to manage symptoms that were present before they elected the hospice benefit
due to unnecessary complications in approving prescriptions under Part D.
The intention of the new Medicare Part D policy implemented by the Centers for
Medicare and Medicaid Services is to prevent the federal government from
incurring duplicate costs for medications of hospice patients.
NHPCO agrees that hospice providers should be held
responsible for all drugs that are related to the terminal diagnoses and those
drugs that are unrelated should be billed to Medicare Part D.
NHPCO acknowledges that there have been instances of Part D payment for drugs
that should have been covered by the hospice provider under the
Medicare hospice benefit.
“The hospice community understands there is a need to address the
issue. NHPCO has worked with CMS on Part D implementation for months now with
limited success,” said Schumacher. “We requested that CMS convene several
different stakeholder groups to determine the best way to carry out this
process so that it would be uniform and effective and we have been denied that
The National Hospice and Palliative Care Organization has
strongly opposed the inadequate and haphazard implementation of this
“The guidance set forth by CMS requiring a claim to be rejected by Part D
before a prior authorization process can begin has created numerous and
unnecessary challenges for terminally ill patients and their families,” says J.
Donald Schumacher, NHPCO president and CEO.
“Hospice providers are being tasked with sorting out a process
that is difficult, lacks standardization and is incredibly time-consuming,
keeping the hospice clinician in the office when they could be in the
field providing care to patients and families.”
NHPCO continues to encourage CMS to halt the implementation of the Part D
guidance and convene key stakeholder groups to collaborate and create a
strategic and uniform process.
An effective solution can be reached so that Part D providers,
pharmacists, hospice providers and beneficiaries have developed a
coherent process together and hospice patients are not denied the medications
they need at the end of life.
With a workable system, hospice patients and their loved ones can
receive the care they need without suffering, confusion and hassle of an
The preceding is the collective opinion
of the National Hospice and Palliative Care Organization released June
9 in a statement to the press.