Update on Accessing Part D Drugs While on Hospice

Update on Accessing Part D Drugs While on Hospice

Earlier this year, the Centers for Medicare and Medicaid Services (CMS) revised its guidance on payment of Part D covered drugs for beneficiaries on Medicare hospice as beneficiaries were having trouble accessing their Part D covered medications due to too many prior authorization requirements put on these drugs. The Medicare Part A hospice benefit covers drugs used for pain control and symptom relief related to terminal illness. These drugs are excluded from Part D.

Under the new guidance, Part D plans are strongly encouraged to only impose prior authorization on 4 drug categories (the ones most used in and covered under hospice care). These are:

  • Analgesics
  • Anti-nauseants
  • Laxatives
  • Anti-anxiety (anxiolytics)

For more details, see CMS’ guidance, Part D Payment for Drugs for Beneficiaries Enrolled in Medicare Hospice (pdf). See our section on Part D appeals for information on how to file an appeal.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.