Advocates blast 'prior authorization' for hospice drugs

Hospice programs and workers are urging the Obama administration to suspend rules they say are limiting patients' access to necessary medications at the end of life.

During a lobby day on Capitol Hill, more than 240 advocates called on Medicare to withdraw a new "prior authorization" process for drugs used for hospice patients.


"We appreciate your agency's effort to protect taxpayer dollars by making sure that Medicare is not paying double for prescription drugs for beneficiaries who have elected hospice care," states a congressional letter to Medicare chief Marilyn Tavenner.

"However, any efforts to address this concern with hospice providers and the Medicare Part D plans cannot be done at the expense of vulnerable patients seeking end-of-life care."

The Centers for Medicare and Medicaid Services finalized the new rules for hospice drugs in March.

The agency reasoned that "prior authorization" would help to ensure the correct division of Medicare was paying for each prescription. Hospice care and related medications are covered under Part A, while other drugs fall under Part D.

"We expect drugs covered under Part D for hospice beneficiaries to be extremely rare," CMS wrote in preliminary guidance on Dec. 6, 2013.

"Therefore, the sponsor should place beneficiary-level prior authorization requirements on all drugs for hospice beneficiaries to determine whether the drugs are coverable under Part D."

Advocacy groups fear that the process will place a heavy burden on beneficiaries to reconcile coverage  in the case of any confusion.

Group met with 330 congressional offices Tuesday to build support for their letter, which Sen. Jay RockefellerJohn (Jay) Davison RockefellerBottom Line World Health Day: It's time to fight preventable disease Lobbying World MORE (D-W.Va.) and Rep. Tom Reed (R-N.Y.) are now circulating.