Medicare Part D: Confused Yet?

By Mery Lossada, MD Chief Medical Officer, Hospice of Marion County

On July 18, 2014, Medicare replaced a policy it had put into place just four months previous. The policy it drew up in March threw hospices and their patients into a tailspin. The disruption was around the Part D prescription plan, which assigns payment for medications. The turmoil was around which medications would be covered and who would paid for them. Needless to say, it made an already gray area even murkier for hospices and patients alike.

As frontline caregivers, the hospice community nationwide led the effort to educate Congress, the Centers for Medicare/Medicaid Services (CMS) and the White House, in addition to engaging with relevant stakeholders. We wrote letters, made phone calls and notified our representatives. Thankfully, our monumental efforts were a success and our voices were heard. The policy has been reversed.

The revised guidance changes the prior authorization by a physician requirement to only four classes of drugs: analgesics (for pain), anti-emetics (for nausea), laxatives (for constipation) and anti-anxiety medications (for anxiety/depression). These are the drugs we hospice physicians most often use to treat symptoms of patients at the end of life. They are our most important resources to keep people comfortable and free of pain and symptoms.

This guidance does not change the responsibility of hospice to pay for all medications related to the terminal illness and related conditions, whether or not they are included in the four classes identified above. That responsibility remains with us.

Part D also covers drugs that may be unrelated to a person’s terminal illness and related conditions. What would those include? Antibiotics, for example, for a respiratory infection or insulin for diabetes. What is not covered by Part D? Multi-vitamins, calcium supplements, cough drops and other over-the-counter medications. Those are the patient’s responsibility.

While Medicare and its myriad regulations continue to evolve, our role at hospice is to take care of our patients. Part of that protocol is keeping on top of government policies that could have an adverse affect on the families we serve. I am delighted to say that this time around, our patients win and hospices around the country can continue providing the expertise only hospice can provide.

Hospice of Marion County Logo
Hospice of Marion County provides a full spectrum of physical, emotional, psychological, social and spiritual support for patients with advancing illness. Visit for more information.