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Hospice Drugs are Covered under Medicare Part A NOT Part D
Hospice programs must provide individuals under hospice care with drugs and biologicals related to the palliation and symptom management of the terminal illness as defined in the hospice plan of care. The only drugs covered by the hospice program are those used primarily for relief of pain and symptom control related to the individual‘s terminal illness. However, because hospice care is a Medicare Part A benefit, the drugs provided by the hospice and covered under the Medicare per-diem payment to the hospice program are not covered under Part D.
Hospice programs are specified in section 1861(dd) of the Social Security Act and in Federal regulations at Part 418.
CMS sends beneficiary-level hospice data to all Part D sponsors. These data are currently sent at the time of the beneficiary‘s enrollment and subsequently whenever the hospice information changes.
CMS suggests that unless the plan has information available at point-of-sale to determine payment responsibility, plan sponsors should pay the claims for drugs furnished to members enrolled in a hospice program that may be covered under the hospice benefit and retrospectively determine payment responsibility.
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