WASHINGTON, July 18 The Obama administration on
Friday backed down on restrictions of private insurance coverage
for hospice drugs under Medicare, saying the regulations were
preventing some terminally ill patients from having access to
The Centers for Medicare and Medicaid Services (CMS) said it
would now require prior-approval for coverage of only four
categories of drugs: analgesics, anti-nauseants, laxatives and
anti-anxiety drugs. In a regulation announced in March, the
government had required prior approval for all hospice drugs
under the Medicare Part D prescription drug benefit.
"Based on discussions with stakeholders, we are adjusting
our rules so that beneficiaries enrolled in hospice will
continue to have access to their medications," CMS spokesman
Raymond Thorn said in a statement.
The change follows a June meeting between officials and
stakeholders including hospice providers, insurers and
pharmacies and patient advocates who described the operational
challenges of requiring all hospice drugs to be approved before
they could be dispensed.
On Friday, the agency acknowledged in a memo to stakeholders
that the March regulations were causing difficulties and "in
some cases, barriers to access for beneficiaries."
CMS issued the initial rule after an investigation by the
Department of Health and Human Services found that the Medicare
program for the elderly and disabled were paying twice for some
Under Medicare's Part A hospital program, hospices receive
daily payments for each patient but are responsible for all
drugs related to a patient's terminal illness. Medicare Part D
covers only prescriptions and medications for curative
conditions that are unrelated to a terminal illness.
The four groups of drugs that remain subject to the
restriction are generally used to relieve discomfort in patients
near the end of life. CMS said it expects Part D claims for
those treatments to be very few, but said it would provide
coverage under the program if a provider simply stated that they
were "unrelated" to the patient's terminal illness.
(Reporting by David Morgan; Editing by Lisa Shumaker)