CMS Policy Hurting Hospice Patients and Families

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National Hospice and Palliative Care Organization voices concern over the flawed implementation of Medicare Part D and hospice policy.

NHPCO is the oldest and largest leadership organization representing hospice in the US.

“The guidance set forth by CMS requiring a claim to be rejected by Part D before a prior authorization process can begin has created numerous and unnecessary challenges for terminally ill patients and their families,” said J. Donald Schumacher, NHPCO.

A hospice patient in Oklahoma City is being denied his medications to treat his COPD, while coping with a diagnosis and treatment for tongue cancer. In Cadillac, Michigan a patient struggling with colon cancer is being denied insulin to treat his diabetes and is in danger of diabetic shock.

Due to a recent and poorly thought out Medicare Part D Prescription Drug policy, dying patients are revoking hospice services to maintain access to other necessary prescriptions for diseases unrelated to their terminal illness that Part D have paid for until recently.

Patients’ families are left at the pharmacy counter with no refill of medications, after the pharmacist announces that because the patient is on hospice, the pharmacy is no longer allowed to fill their prescriptions – which is not accurate. Or they are going days, sometimes weeks, without the necessary medication to manage symptoms that were present before they elected the hospice benefit due to unnecessary complications in approving prescriptions under Part D.

The intention of the new Medicare Part D policy implemented by the Centers for Medicare and Medicaid Services is to prevent the federal government from incurring duplicate costs for medications of hospice patients.

NHPCO agrees that hospice providers should be held responsible for all drugs that are related to the terminal diagnoses and those drugs that are unrelated should be billed to Medicare Part D.

NHPCO acknowledges that there have been instances of Part D payment for drugs that should have been covered by the hospice provider under the Medicare hospice benefit.

“The hospice community understands there is a need to address the issue. NHPCO has worked with CMS on Part D implementation for months now with limited success,” said Schumacher. “We requested that CMS convene several different stakeholder groups to determine the best way to carry out this process so that it would be uniform and effective and we have been denied that opportunity.”

The National Hospice and Palliative Care Organization has strongly opposed the inadequate and haphazard implementation of this guidance.

“The guidance set forth by CMS requiring a claim to be rejected by Part D before a prior authorization process can begin has created numerous and unnecessary challenges for terminally ill patients and their families,” said J. Donald Schumacher, NHPCO president and CEO. “Hospice providers are being tasked with sorting out a process that is difficult, lacks standardization and is incredibly time-consuming, keeping the hospice clinician in the office when they could be in the field providing care to patients and families.”

NHPCO continues to encourage CMS to halt the implementation of the Part D guidance and convene key stakeholder groups to collaborate and create a strategic and uniform process. An effective solution can be reached so that Part D providers, pharmacists, hospice providers and beneficiaries have developed a coherent process together and hospice patients are not denied the medications they need at the end of life.    

With a workable system, hospice patients and their loved ones can receive the care they need without suffering, confusion and hassle of an ill-conceived process.


Representative Patient Stories:
•Cadillac, Michigan, May 2014
Patient is on hospice for colon cancer; was denied insulin which is not related to the colon cancer and is not paid by the hospice for the palliation or symptom management of colon cancer. Delay in getting insulin to the patient and an out of pocket expense of $373.75 for a 25-day supply of insulin.

•Oklahoma City, Oklahoma, May 2014
Patient is on hospice for tongue cancer. He has COPD and uses Symbicort and Proair. He was unable to refill these meds under his Part D benefit. Hospice sent pre-authorization to the Part D sponsor but they would not accept because the medications were prescribed by the primary care physician. Patient went without medications for a week. This incident caused undue stress to the patient and his family, not to mention significant breathing issues from going without medication for a week.

•Dayton, Ohio, May 2014
Hospice patient with Alzheimer’s dementia who resides in a nursing home and has an unrelated secondary diagnosis of hypothyroidism. The patient went without their Synthroid for 4 weeks due to lack of awareness and understanding of the part D changes by all of the caregiving entities. The patient experienced fatigue, constipation, and fluid retention because of the absence of the drug.

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Jonathan Keyserling

Anita Brikman

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