Medicare Improves Medication Coverage for Hospice Patients

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Back to Blog shutterstock 155957624 Medicare Improves Medication Coverage for Hospice Patients Medication Coverage Medicare Part D Medicare Hospice Family End of Life Management End of life care end of life chronic condition medications

There’s good news about Medicare prescription coverage for thousands of hospice patients nationwide. We found an encouraging story that reviews Medicare’s new policy on facilitating its medication coverage process for hospice patients. As of July 2014, Medicare significantly eased its rules for insurance coverage of pre-existing chronic condition medications for hospice patients. The new policy comes in response to long-held concerns voiced by patient advocates and members of Congress. The new policy may eliminate over 95 percent of the cases in which hospice patients need prior approval from an insurance company to get coverage for their chronic-condition medications, according to participants in a recent Medicare briefing. Physicians identify hospice patients as suffering from a life-limiting condition with an expected six months or less remaining life. Many hospice patients have additional chronic conditions that complicate their final care. Until July 2014, getting Medicare prescription coverage for these conditions has proven difficult for many hospice patients and their families and caregivers. For example, a hospice patient who is dying from a terminal disease like cancer might also be taking prescription drugs to manage congestive heart failure – a condition that complicates his or her End-of-Life condition and care. The previous policy required hospice patients to get prior approval from their Medicare Part D insurer before a prescription for pre-existing conditions could be covered. According to a recent story from, the delays became a lengthy and challenging process. Many prescriptions went unfilled due to the lengthy time involved to get approval. Further, some hospice patients could not afford their medications without Medicare insurance coverage. As a result, many families felt that this compromised the quality of hospice care for their terminally ill loved one. The change in Medicare policy “will help tremendously” said Theresa Forster, vice president for Hospice Policy & Programs at the National Association for Home Care & Hospice. The new policy will require prior approval from Medicare Part D insurers for only four classes of medications: analgesics, anti-nauseants, laxatives and anti-anxiety drugs, Medicare said. Since these drugs “are nearly always covered under the hospice benefit,” the Center for Medicare and Medicaid Services (CMS) said in a policy statement, “the approval process required for them will be unnecessary in most cases.” The new policy “will greatly relieve the stress that patients and families, as well as care providers, were experiencing under the prior Medicare approval process” said Jonathan Keyserling, senior vice president and counsel in the Office of Health Policy for the National Hospice and Palliative Care Organization (NHPCO) and executive director of the Hospice Action Network (HAN), the advocacy arm of the NHPCO. Read the story here. Save


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