CMS scales back prior-authorization policy for hospices.

Abstract

The Centers for Medicare and Medicaid Services (CMS) on July 18 eased a weeks-old policy that had sent hospice programs scrambling to secure Medicare Part D coverage for medically necessary medications not included in the hospice benefit. “We are all kind of breathing a sigh of relief” after the July policy revision, said Pamela S. Moore, clinical lead pharmacist in pain and palliative care at Summa Health System in Akron, Ohio. The original policy, which went into effect May 1, 2014, had instructed Part D plan sponsors to subject all drug claims for hospice patients to prior-authorization requirements. “We have over 200 patients on our home hospice service, so it had a pretty significant impact,” Moore said. “It was very difficult to maintain continuity of those patients’ regimens.” Moore said each day at the hospice program began with “multiple physicians, multiple nurses, myself, hospice administrators, all in a room just going through the new admissions” to determine how to bill for each patient’s medications.