New Guidelines From Medicare About Who Pays For A Patient’s Medicines In A Hospice

As of March 1, 2014, a new Medicare regulation requires that the hospice pay for any drug needed to keep a patient comfortable.  Medicare has always intended that a hospice provides or pays for comfort-focused drugs out of the daily amount Medicare pays the hospice.  However, investigators found that some hospices were having the patient obtain them through Part D coverage, saving the hospice money to increase profits.


Medicare’s thinking behind this rule is that since most other diseases or conditions have an impact on the primary diagnosis (the terminal disease making the patient eligible for hospice), the hospice agency should be responsible for providing any drug necessary not only for that primary disease but also for the other conditions.  This will naturally result in every hospice attempting to reduce the number of drugs a patient takes—and that’s actually a good thing!  Why?
Because many drugs taken for ‘other’ conditions are beneficial only when taken ‘long term’ and since hospice patients have an expected survival of less than six months (with many only living a few weeks—because they get referred too late), most of those ‘other’ drugs will not help them to live any better during their final few months. 
So, what’s this really mean?  This is what you should expect to see from every hospice [and certainly will from Hospice of the Shoals]:

 

  1. The nurse-doctor team clarify with you which drugs are most likely to help you remain comfortable; and which ones will most likely not do so (might actually now be harmful) and could be stopped.
  2. Drugs considered unhelpful will NOT be covered by either hospice or Medicare Part D.  In fact, NONE of the drugs you take will be covered by Part D [appeals for exemption will not likely be successful—so we are told].  If you believe you need them, you will have to buy them yourself.
  3. If you take a drug which we agree is essential to your comfort, we will either pay for it or we may substitute it with one from our drug formulary—a list of generic drugs just as effective but less expensive (just like insurance companies do).

Something else to remember:  patients who cut back on ‘non-comfort’ meds generally feel better and live longer!! You need to trust your hospice team to give you some common sense advice.