All prescriptions for hospice patients require prior authorization

To ensure drug claims for hospice patients are paid under the correct plan, as of May 1, 2014, all prescriptions for hospice patients require prior authorization. You can obtain prior authorization for hospice patients through the usual process with the Pharmacy Clinic Help Desk. You can access the phone directory with the appropriate help desk numbers by clicking here.

There may be some medications used before the patient’s hospice enrollment that will continue as part of the hospice plan of care. Prior to hospice enrollment, these drugs were paid under Medicare Part D. When the patient enters hospice, coverage switches to Part A as part of the hospice’s bundled per-diem payment.

Prescriptions for conditions unrelated to the terminal illness and its related conditions may be covered under Part D. For Part D payment, in addition to prior authorization, we require supporting documentation confirming that the treatment is unrelated to the terminal illness.

If a hospice patient attempts to fill a prescription at a pharmacy, the claim will be rejected and indicate that prior authorization is required. We notified pharmacies and affected members of this change in mid-April.

If you’re providing health care services to a hospice patient for a nonrelated condition and are not affiliated with the hospice provider, we encourage you to coordinate care with the hospice. This makes it easier for your patient to fill their prescription at a pharmacy in the future.