CMS Cuts Back on Hospice Drug Restrictions

The Centers for Medicare & Medicaid Services (CMS) has scaled back its restrictions requiring all hospice drugs to be approved before they can be dispensed. 

Now, prior authorization will only be necessary for four categories of prescription drugs: analgesics, anti-nauseants, laxatives and anti-anxiety medications, according to a recent CMS memorandum.

“We recognize that the operational challenges associated with prior authorizing all drugs for beneficiaries … have created difficulties for Part D sponsors and hospice providers, and in some cases, barriers to access for beneficiaries,” CMS writes.

The new memorandum revises the agency’s final guidance in March on Part D payment for beneficiaries enrolled in hospice, requiring providers to authorize all medications. 

CMS worked with the Office of the Inspector General (OIG) and the National Hospice and Palliative Care Organization (NHCPO) to moderate the March regulation and to determine the four classes of drugs that will require prior authorization. 

Access the memorandum.

Written by Emily Study