CMS Revises Part D Prior Authorization Requirement for Hospice Patients

The Centers for Medicare & Medicaid Services (CMS) released a memorandum July 18 notifying Part D sponsors and hospices that it has revised its March 10 guidance on prior authorization.

Recognizing that requiring prior authorization for all drugs could prevent hospice patients from receiving certain medications they so desperately need in a timely manner, CMS is now “strongly” encouraging sponsors to place beneficiary-level prior authorization requirements on only four categories of prescription drugs: analgesics, antinauseants (antiemetics), laxatives, and antianxiety drugs (antiolytics).

And, though these four drug categories require prior authorization, CMS has indicated that it expects Medicare hospice providers to put patients’ needs first.

“We anticipate these drugs are the least likely to be subject to disputes concerning payment responsibility and any barriers to beneficiary access to prescription drugs will be minimized.”

Further, CMS encourages hospice providers to report a patient’s Medicare hospice election to the Part D sponsor and identify any drugs in the four categories that are unrelated to the terminal illness and/or related conditions prior to the submission of a claim. The sponsor may then override prior authorization at the point of sale.

See the July 18 memorandum for other new guidance directed toward hospice providers and Part D sponsors.

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Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

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Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

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