When a patient elects hospice, the hospice provides all of the care related to the terminal illness and related conditions. Patients at the end of life may also have several different medical conditions with which they have struggled for years but are not related to the terminal condition. In these cases, the other medical conditions are not the responsibility of the hospice; they are the responsibility of the patient’s primary insurer, which is usually Medicare, and Medicare Part D for medications.
In March 2014, CMS issued guidance to the Part D provider and hospice communities introducing a “prior authorization” process for how the two groups should determine who pays for which drugs once a patient enters hospice. Members of Congress have called for CMS to slow the process and convene the stakeholders to create the appropriate communication channels and processes for prior authorizations. However, CMS has provided little instruction and absolutely no infrastructure to ensure that hospices and Part D plans can successfully implement this process without impacting patient access to medications. NHPCO and HAN have developed the Policy Points video and many other resources for Advocates and allies to better understand this complicated issue.
Thanks to the hard work of Hospice Advocates across the country, 75 Senators and 202 Members of the House of Representatives signed on to letters asking CMS to temporarily lift implementation of current Part D and hospice guidance and work collaboratively with relevant stakeholders toward a better policy solution. To view a complete list of all co-signers, click here.
- 7/18/14 NHPCO Press Release: Part D Interim Guidance
- 7/18/14 CMS Revised Guidance on Part D
- Letters from Congress to CMS
- 06/11/14 Stakeholder Community Letter to CMS
- Early Correspondence with CMS
- 10/31/2013 Press Release on the CMS Part D Clarification
For an comprehensive collection of resources on Part D and hospice, including an interactive timeline, visit the archives on this issue.