More than 1.3 million patients are cared for by hospices each year; most are seniors. In fact, 82% of hospice patients are aged 65 and older and at least 10% have dementia.1 Consultant and senior care pharmacists and pharmacies provide invaluable, cost-effective medication-related services to this practice setting.
Hospices that accept Medicare payment – 93% of which do1 – must comply with new federal regulations beginning in December 2008! Those regulations require hospices to consult with an “individual with education and training in drug management.” This is a prime opportunity for consultant and senior care pharmacists to market and sell their services to hospices.
Dispensing pharmacies play a huge role in hospice as well. For example, pharmacies supplying hospices often provide emergency pain medications and “stat” deliveries in addition to compounding alternative dosage forms for medications. The average hospice spends $123,842 annually to provide medications and biologics for its patients or $15.72 per patient day.2 Hospices rely upon pharmacies to help them manage costs and to provide timely, personalized services.
ASCP Advocacy for Hospice Enrollee Medication Access
ASCP Policy & Advocacy staff have received a number of reports from members regarding problems related to coverage of Part D drugs for hospice enrolled beneficiaries. The problems are related to a new guidance document published by CMS March 10 and involve a blanket prior authorization policy for all Part D claims submitted for hospice enrollees. The new policy has created access barriers for these patients as well as difficulty getting claims paid for enrollees in long-term care facilities. Staff and and leaders have met with officials from the Centers for Medicare & Medicaid Services (CMS), as well as representatives from the Senate Finance and House Ways & Means Committees, to address ongoing problems related to the CMS hospice drug coverage guidelines published March 10. ASCP is working closely with other stakeholder organizations such as the National Hospice and Palliative Care Organization and the Pharmaceutical Care Management Association.
Additionally, ASCP submitted comments July 1 in response to a CMS public solicitation for comments on the guidance in contemplation of a future rulemaking. ASCP used the opportunity to document prior authorization processing and medication access barriers observed in the field as a result of the current guidance. We also reiterated our request to suspend the guidance until more appropriate guidance can be established.
The following resources are ASCP members-only content. If you are a member, make sure you log on to access the complete content of this document.
Shop the online ASCP Store
Read related The Consultant Pharmacist journal articles