CMS issues revised guidance on Part D drug payment for hospice patients

AHA News

The Centers for Medicare & Medicaid Services (CMS) July 18 issued revised guidance on Medicare Part D payment of drugs for beneficiaries enrolled in hospice care.

The agency said the document supersedes portions of its March 10 guidance to address operational and beneficiary access concerns raised by the field.

“Our goal for the policy we set forth in March was to ensure that the hospice and Part D programs correctly pay for prescription drugs covered under
each respective Medicare benefit while ensuring timely access to needed prescription medications,” the new guidance states.

“While this remains CMS’s objective, we recognize that the operational challenges associated with prior authorizing all
drugs for beneficiaries who have elected hospice to determine whether the drug is coverable under Part D have created difficulties for Part D sponsors and hospice providers, and in some cases, barriers to access for beneficiaries.”

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Topic: Advocacy and Public Policy

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