In response to聽strong criticism, Medicare officials are modifying rules intended to prevent the agency from paying twice for the same prescriptions for seniors receiving hospice care.
Under that took effect in May, hospice patients or their families through their Part D drug plans until first confirming that the prescriptions were not covered by hospice providers.聽 Drugs related to palliative and comfort care are supposed to be covered under the fixed rate payments to.
Medicare announced Friday that the so that the additional authorization would be required for only four types of medications: 聽pain relievers, anti-nauseants, laxatives, and anti-anxiety drugs that are 鈥渘early always鈥� considered hospice-related.
鈥淢edicare really tried to address our concerns quickly and effectively,鈥� said Terry Berthelot, a senior attorney at the Center for Medicare Advocacy. 鈥淭hey really did a good job and even though it鈥檚 not perfect, it鈥檚 so much better.鈥�
The four drug categories were identified in a by the Department of Health and Human Services鈥� inspector general. Investigators found that Part D prescription drug plans paid more than $33 million in 2009 that should have probably been covered by the hospice benefit. Part of those overpayments also were for 聽prescription drugs used to treat pulmonary problems and amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig鈥檚 disease. Beneficiaries paid nearly $4 million in copayments, the report by the Department of Health and Human Services鈥� inspector general found.
鈥淏ased on discussions with stakeholders, we are adjusting our rules so that beneficiaries enrolled in hospice will continue to have access to their medications while balancing recommendations by the Inspector General meant to safeguard the Medicare program,鈥澛爏aid Medicare spokesman聽 Raymond Thorn.
Medicare officials revised the rules after meeting in late June with beneficiary advocates, hospice providers, insurers offering Part D drug plans and pharmacists.
Medicare generally pays drugs for diabetes, heart disease or other chronic conditions still used by hospice patients but not directly related to their terminal illness. Those are covered by Medicare Part D prescription drug plans, which are heavily subsidized by Medicare, with beneficiaries picking up roughly 25 percent of the bill.
Contact Susan Jaffe at Jaffe.KHN@gmail.com