CMS Eases Medicare Prior Authorization Rules for Hospice Programs
On Friday, CMS officials revoked the prior authorization process for some drugs used in hospice care, after stakeholders said the requirement was limiting access to essential medications for terminally ill patients, Reuters reports (Morgan, Reuters, 7/18).
In March, CMS finalized rules requiring prior authorization for drugs used by hospice patients.
CMS said the process would ensure the right Medicare division was paying for each prescription. Hospice care and any related drug treatments are covered under Medicare Part A, while other drugs are covered by Part D (Morgan, Reuters, 7/18).
In its revised guidance, CMS is requiring prior authorization for only four types of medications that are "nearly always" hospice-related, including:
- Anti-anxiety drugs;
- Laxatives; and
- Pain relievers.
According to Kaiser Health News' "Capsules," the four categories were decided upon after an HHS investigation found Part D plans paid more than $33 million that should have been covered by Part A in 2009 (Jaffe, "Capsules," Kaiser Health News, 7/18).
Further, CMS established a "pathway" through which hospice providers can prescribe the drugs for patients in cases unrelated to terminal illness. In such an event, providers can bill Part D by noting the medication is not for hospice care (Viebeck, The Hill, 7/18).
The new guidelines come after hospice advocates in June urged the Obama administration to suspend the prior-authorization process, citing the challenges that came with requiring hospice drugs to be approved before being dispensed.
CMS spokesperson Raymond Thorn said the department is "adjusting our rules so that beneficiaries enrolled in hospice will continue to have access to their medications" (Reuters, 7/18).
This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.