Kaiser Health News and the Washington Post collaborated on a story about the overpayment of medications for Hospice patients. New Medicare guidance aims to stop the federal government from paying millions of dollars to hospice organizations and drug insurance plans for the same prescriptions for seniors. The new measures direct insurers not to pay for any prescriptions for hospice patients until they receive confirmation that the drugs are not covered instead by the hospice provider. The patient or doctor, with the hospice provider’s agreement, must explain to the insurer why the drug is not related to end-of-life care. The insurer may deny coverage for a number of reasons, including if the doctor or hospice did not explain sufficiently why the drug was unrelated to the terminal illness.
Medicines for Medicare patients receiving hospice care generally are paid in two ways. Drugs related to palliative and comfort care are supposed to be covered under the fixed-rate federal payments to the hospice. Drugs for diabetes, heart disease or other chronic conditions still used by these patients but not directly related to their terminal illness 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.
The new measures are a response to a 2012 investigation that found Part D prescription drug plans paid more than $33 million in 2009 that should have probably been covered by the hospice benefit. That was for analgesic, anti-nausea, laxative and antianxiety drugs, as well as prescription drugs used to treat pulmonary problems and amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. Beneficiaries paid nearly $4 million in copayments, the report by the Department of Health and Human Services’ inspector general found.
About 1.1 million Medicare beneficiaries received hospice care in 2009 and 437,121 filled prescriptions through their Medicare drug plan, according to the report.