NAHC, Other Stakeholders Advocate on Hospice/Part D Issues with White House Staff
May 16, 2014 03:32 PM
On Tuesday, May 13, representatives of the National Association for Home Care & Hospice (NAHC), the Center for Medicare Advocacy, the Medicare Rights Center, and the National Hospice and Palliative Care Organization (NHPCO) met with a member of the White House Domestic Policy Staff to discuss continuing problems related to CMS’ requirement that Part D plans impose a beneficiary-level prior authorization (PA) for drugs prescribed for hospice patients.
During the meeting, advocates argued that imposition of a PA process at the beneficiary level for terminally ill patients is particularly inappropriate as any PA process slows access to medications and creates difficulties that dying patients and their loved ones should not be subject to.
The group urged withdrawal of the PA requirement, citing countless problems, among them: failure of Part D plans to follow the PA guidance issued by CMS; widespread refusal by Part D plans to enter into advance discussions with hospices to establish responsibility for drug coverage so that rejection of coverage could be avoided when the patient goes to the pharmacy to fill prescriptions; refusal of Part D plans to accept direct information from hospices on patient status - resulting in patients no longer on hospice being refused all Part D drug coverage; and misunderstanding of the PA process at the pharmacy level that results in the provision of misinformation to the patient.
Stakeholders also described the additional complexities and challenges related to failure of the prescribed PA process for patients in nursing facilities to White House staff during the meeting.
The PA process was required by CMS guidanceto Part D plans that was implemented on May 1. For more on CMS Guidance and Part D, please see NAHC Report, May 14, 2014.
STORIES ARE NEEDED
NAHC and others will continue to fight the Part D PA policy. In order to do so, hospice providers must submit stories that illustrate the serious issues that are arising for patients, family members, and hospices as the result of CMS’ imposition of the PA process.
In an effort to simplify submission of stories, NAHC has developed a brief online survey tool (seven questions)for use by hospices to submit descriptions of incidents where the PA policy has created problems. The survey is open to all hospices, regardless of membership. Participation is very much appreciated and will help with efforts to educate The White House, CMS, and Congress on the many negative consequences arising from imposition of the Part D prior authorization requirement for hospice patients.