So the buzz is around the office today about new Medicare Part D changes that are going to majorly and adversely affect patients and their families, and also be the death knell for hospices throughout the country.
See the following link for the actual final determination and new rules that are supposed to be effective May 1, 2014:
The Readers' Digest version of this new policy is that patients, once enrolled onto hospice services, will only be covered for medications directly related to the palliation and symptom management of their illness. In example, Sally Jones is admitted to hospice with a Dx: Cervical Cancer. Medicare will now only cover medications directly related to this illness (e.g. Analgesics, Anti-Emetics, Laxatives/Stool Softeners, Anti-Anxiety). But if Sally Jones also suffers from COPD and is also s/p CABG, medications related to those diagnoses will no longer be covered under Medicare Part D and will become the liability of the patient or the hospice provider if they so choose to cover the medications.
So what this means is that hospice patients facing terminal illness for one problem may very well become at greater risk secondary to other comorbidities than their primary diagnosis. Additionally, this will add financial stressors to families already dealing with terminal illness. Coupled with the cuts already hitting hospice providers last year, this is surely going to sink some hospices altogether. And we'e already seeing patients getting their rejection notices for medications two months ahead of this change being implemented.
I'm curious to know thoughts on this. Is this buzzing within your own work culture? Better freshen up those resumes, ladies and gents, because this could be a game changer.
You misunderstood if you interpreted my post to mean the pt has to pay out of pocket for a HOSPICE FORMULARY EQUIVALENT. hospice covers ALL formulary meds 100%. If the Pt refuses to try a formulary alternative, then the pt has the right to pay out of pocket.
In speaking towards an earlier post....yes, at times we have pts who have been treated for depression for years & years prior to hospice. Some hospice companies argue its not their responsibility to cover bc has been long term. I disagree. This exact attitude is why Part D is no longer willing to cover unrelated meds without PA.
So there is a hospice formulary equivalent for duloxetine?
Specializes in NICU, PICU, Transport, L&D, Hospice.
So there is a hospice formulary equivalent for duloxetine?
Wouldn't venlafaxine be a reasonable and more affordable alternative? This is something that should be discussed with the hospice pharmacist and the medical director, of course, but duloxetine at $3-5/tablet is on the pricey side for hospice, in my view.
Specializes in NICU, PICU, Transport, L&D, Hospice.
Yes there are several. It just depends what it's being used for (neuropathic pain, antidepressant).
If it is being used for pain control there is an expectation that hospice should pay for and manage it as part of the pain POC, even if the pain is secondary to the DM2 and not the cancer (for example). Hospice is charged with managing the comfort of the patient, palliating their pain, and improving the quality of life relative to comfort and pain. It makes no sense to create inconsistency in pain management care simply for a monetary concern of the hospice agency. THAT is not representative of patient centered or whole person care that hospice is supposedly famous for. IMHO
If it is being used for pain control there is an expectation that hospice should pay for and manage it as part of the pain POC, even if the pain is secondary to the DM2 and not the cancer (for example). Hospice is charged with managing the comfort of the patient, palliating their pain, and improving the quality of life relative to comfort and pain. It makes no sense to create inconsistency in pain management care simply for a monetary concern of the hospice agency. THAT is not representative of patient centered or whole person care that hospice is supposedly famous for. IMHO
Most hospices would try other neuropathic meds within formulary before trying exotic meds. There should be many old school and cost effective choices to try first (TCAs, anticonvulsants, local anesthetics, etc). If they don't work THEN one can consider exotics. That is representative of modern, cost effective medicine including today's hospice care.
I'm not sure how this keeps turning into an old school hospice debate.
Specializes in NICU, PICU, Transport, L&D, Hospice.
Most hospices would try other neuropathic meds within formulary before trying exotic meds. There should be many old school and cost effective choices to try first (TCAs, anticonvulsants, local anesthetics, etc). If they don't work THEN one can consider exotics. That is representative of modern, cost effective medicine including today's hospice care.
I'm not sure how this keeps turning into an old school hospice debate.
Hospice patients often come to hospice with "exotic" meds already on their POC. That is the example given.
It is not a debate about old school v. new school hospice, it is a discussion of which medications might reasonably and rightly be included on the hospice POC versus paid for by another route.
I can assure you there are numerous other medications, for pain or depression, which can be used in the place of cymbalta. Medicare doesn't require hospices to cover non-formulary medications. If that were the case, all hospices would be broke. A lot of times a cheaper alternative works better anyway.
We could go on and on about what hospices SHOULD do....but that means nothing. Absolutely nothing. Wasted breath and wasted space. The bottom line is what Medicare REQUIRES hospices to do......which BTW is what I thought this thread was about to start with.....
Specializes in NICU, PICU, Transport, L&D, Hospice.
I can assure you there are numerous other medications, for pain or depression, which can be used in the place of cymbalta. Medicare doesn't require hospices to cover non-formulary medications. If that were the case, all hospices would be broke. A lot of times a cheaper alternative works better anyway.
We could go on and on about what hospices SHOULD do....but that means nothing. Absolutely nothing. Wasted breath and wasted space. The bottom line is what Medicare REQUIRES hospices to do......which BTW is what I thought this thread was about to start with.....
The thread is about revisions to the regulations, right?
I've worked as a surveyor/regulator for my state and CMS in the past, and, in my experience, these kinds of rule changes are always reactive, not proactive. In other words, they are usually implemented as a response to some widespread, longstanding problem, which I suspect, in this situation, is likely inappropriate/excessive charges (or, at least, sloppy work) by too many hospices around the country.
I would expect that it is not a "death knell" for hospices so much as a "wake-up call." Hospices that are committed to providing people appropriate services will manage to continue to serve families within the new guidelines and requirements. Hospices that are primarily looking to maximize revenues/incomes will be in some trouble.
I believe that hospices have been engaged in NOT doing what they SHOULD do and that is the reason that we experience reactive rule changes.
I think that knowing what we should do within our specialties is important. Knowing what we should do helps us to advocate for our patients, right?
I can assure you there are numerous other medications, for pain or depression, which can be used in the place of cymbalta. Medicare doesn't require hospices to cover non-formulary medications. If that were the case, all hospices would be broke. A lot of times a cheaper alternative works better anyway.
We could go on and on about what hospices SHOULD do....but that means nothing. Absolutely nothing. Wasted breath and wasted space. The bottom line is what Medicare REQUIRES hospices to do......which BTW is what I thought this thread was about to start with.....
Don't hospices come up with their own formularies? There is no master list of medications on formulary that's produced by anyone other than the hospice facility/company?
The issues seems to be that supposedly Medicare is limited what medications a patient can receive while on hospice, and you've given the example of duloxetine. But as far as I can tell it's the hospice facility/company that is choosing to make that unavailable in the situation you describe.
Specializes in NICU, PICU, Transport, L&D, Hospice.
Don't hospices come up with their own formularies? There is no master list of medications on formulary that's produced by anyone other than the hospice facility/company?
The issues seems to be that supposedly Medicare is limited what medications a patient can receive while on hospice, and you've given the example of duloxetine. But as far as I can tell it's the hospice facility/company that is choosing to make that unavailable in the situation you describe.
Bold mine.
In theory this is true, the hospice determines it's own formulary.
In practice I find that if the hospice is using a service like Enclara or Hospice Pharmacia (as example) the pharmacy service provides a formulary upon which their rates are based. Most hospices, in my experience accept those formulary as adequately comprehensive for the most part.
MunoRN, RN
8,058 Posts
So there is a hospice formulary equivalent for duloxetine?