Recent Advocacy Efforts on Part D Prior Authorization for Hospice Patient Medications
NAHC’s Forum of State Associations; 75 U.S. Senators Send Letters to CMS Opposing Part D Prior Authorization Requirements
July 3, 2014 08:53 AM
Earlier this week, the Forum of State Associations, a NAHC affiliate that is comprised of state-based home care and hospice associations from across the nation, sent a letter to CMS Administrator Marilyn Tavenner expressing, “concerns related to the negative beneficiary consequences that are resulting from the Centers for Medicare & Medicaid Services’ (CMS) imposition of a beneficiary-level prior authorization (PA) requirement for all drugs processed by Part D plans for patients who are enrolled in the Medicare hospice program.”
The letter was endorsed by all state members of the Forum of State Associations, and also offered support of the letter that was recently sent by 45 national advocacy organizations to CMS that also expressed concerns about the PA requirements. NAHC was a signatory to the latter letter.
The letter sent by the Forum of State Associations states that:
“[H]ospice providers report that the new PA process is creating significant delays in the dispensing of vitally important medications, is increasing out-of-pocket costs for hospice beneficiaries and is creating massive confusion for Medicare hospice beneficiaries and their families. Further, efforts by hospice providers to address questions of coverage responsibility at the front end or to communicate patient status information directly to plans (as advised by CMS’ guidance and FAQs on this issue) are in large part being rebuffed.”
In the same week that the Forum of State Associations sent its letter to Administrator Tavenner, a letter signed by 75 bipartisan members of the US Senate expressing their concerns with CMS’ Prior Authorization requirements was sent as well.
The Senate letter states that:
“While well-intentioned, the prior authorization process that you have established for the medications of Part D beneficiaries who have elected hospice could result in delayed access to medication for a population that, by very definition, does not have time to spare… While this confusion is sorted out, it is imperative that care for Medicare beneficiaries at the end of life not be negatively impacted.
For this reason, we ask that CMS immediately suspend the Guidance and begin a process to develop an alternative approach which will ensure both that the right individual or entity pays for the hospice patient’s medications and that the patient get the medication that he or she requires without interruption.”
To read the Forum letter, please click here.
To read the Senate letter, please click here.
For more information on the Part D issue, please see NAHC Report, June 27, 2014 and NAHC Report, June 13, 2014.