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.
