Print Friendly, PDF & Email

Research suggests that medications that should be covered by the Medicare Hospice Benefit are sometimes paid for by Medicare Part D plans. In March, to prevent this from happening, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum to Part D Plan Sponsors and Medicare Hospice Providers entitled, "Part D Payment for Drugs for Beneficiaries Enrolled in Hospice – Final 2014 Guidance" (Guidance).  See the Center's April 10, 2014 Alert "Hospice and Access to Medications – New CMS Guidance."  CMS' Guidance is available at: The Guidance requires Part D plans to initially deny payment for all prescribed medications for hospice patients. Hospice patients will then have to appeal the denials in order to get Part D payment for their medications.    

On June 11, 2014 the Center for Medicare Advocacy and 26 other organizations sent a letter to CMS Administrator Tavenner expressing concern that the Guidance places Medicare beneficiaries at the center of potential disagreements between hospice providers and Part D plans — essentially requiring dying patients to navigate payer disputes about coverage for necessary medications.  The letter urges CMS to replace the Guidance with a more suitable solution.

Comments are closed.