U.S. Medicare program scales back hospice drugs restrictions

[n2doc]

Source: Reuters

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 medicine.

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.

Read more: http://www.reuters.com/article/2014/07/18/usa-medicare-hospices-idUSL2N0PT26D20140718?irpc=932

[Mojorabbit]

1. Analgesics and meds for nausea are probably the most common meds used in hospice

from my experience with family members who used the program before passing.

[Dustlawyer]

2. There are so many roadblocks to get pain relief for any reason.

I have to drive 2 hours each way every month because I have to pick up a schedule 1 narcotic in person instead of mailing it to me or sending to the pharmacy where I willingly show proof it is me.

I drive that far because my local pain management doctor, whose instructions I followed to the letter, told me he had made a mistake with me and needed to try something different (again) to reduce my narcotics. I told him sure and he laid out a plan where he would take one of the two types away and replace it with yet another non-narcotic med that he hadn't tried yet (in the same family as some others I had been allergic to I found out later). I get to the pharmacy about 6 p.m. Friday evening to pick up the new drug and the other narcotic I had been on only to find he only sent in the new drug. All weekend I went through terrible withdrawals and broke out in whelps from an allergic reaction to the new med which I stopped taking immediately. So now I had nothing for pain, dizzy even sitting down, throwing up, muscle aches, no sleep. All because a doctor, who had promised me when I asked at the beginning when he said he was trying narcotics, that he would wean me off when the time came. Because I had fired him, no other local pain management doctor would see me!

I am allergic to all but one of the non-narcotic pain relievers for my small fiber sensory neuropathy. It is the most painful form of neuropathy where sometimes it feels like I am being shocked suddenly by a cattle prod, on fire, covered in fire ants, muscle cramps so bad they have torn my muscles... I have had a neural stimulator implanted in my spine because doctors told me before I got it that it would allow me to take less medicine. After getting it (it hurt like hell) I found that it didn't and the little shit head then told me, "of course it doesn't reduce the amount of meds you need, it will help to take your mind off your pain for awhile!" I could have smacked him!

I found a great doctor far away and so this is how I live. I am going on long term disability and hopefully Social Security Disability due to the meds I take. I worked hard for my law license and am middle aged. Because Texas will be the last Mother Freakin State to legalize medical marijuana, I still will need to take this crap. I don't see what the pill heads like about this. I stay on one dose so long it stops the high feeling within a week or two of upping the dose, but it keeps me from thinking clearly, and I try to put up with as much pain as possible because I have to trade pain relief for clarity. I can no longer do it. In one respect, BP kept me practicing longer because I traveled the Gulf Coast signing up BP cases for 3 years. I could do that but not handle a docket. My boss has carried me this last year but it appears it is time for me to go. Sorry for the rant but this shit gets to me bad! I really wanted to be there when we finally get BP's lying ass in a courtroom again! We kicked their ass in Texas City (They actually budgeted for their own workers lives and mad fun of it all in the same document)!

Help get medical pot passed everywhere to help all of us who suffer needlessly! If a Democratic President does this half measure, what will the Republicans do when they get the Presidency and both Houses again. America's amnesia of what they do when they have the power is incredible!

[NCarolinawoman]

3. *

You have gone through too much. It should not have to be this way.

[DeadLetterOffice]

5. No worries -- pain meds & anti-nausea meds are part of covered hospice care.

They're covered as part of the daily rate paid to hospice for each patient. So they hardly ever get billed to Medicare D and thus hardly ever need prior approval.

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.

[DeadLetterOffice]

4. The big problem was meds that people were coming onto Hospice already using.

Last edited Fri Jul 18, 2014, 08:58 PM - Edit history (1)

People were coming onto the program and -- *poof* -- couldn't get coverage for meds they were taking for any other non-terminal conditions. So the lung cancer patient who was on blood pressure medication all of a sudden needed prior approval for the BP meds. Which, when you have to take a given medication every single day, and it was taking days to get prior approval, was something of a problem. Not to mention the HOURS of time case managers were having to spend getting prior approval instead of other things like, you know, patient care.

So yay for the administration getting rid of a truly stupid rule (that they never should have put in place to begin with).

[GeorgeGist]

6. Sometimes I think they'd just as soon the patient use bullets ...

to escape Dumbfuckistan.