How to Determine Hospice Coverage

Hospices are required to cover medications that are reasonable and necessary to relieve patient symptoms and optimize quality of life, not to manage terminal illnesses and related conditions. Hospices are not expected to pay for curative medications or medications that slow disease progression. Specifically, hospices MUST cover 4 classes of medications: analgesics, anxiolytics, antiemetics and bowel care medications. We also suggest covering some pulmonary medications, such as albuterol and morphine for shortness of breath. To keep this simple, just remember the 5 P\’s of Hospice:

  1. PAIN – bone/nerve pain
  2. PUKE – nausea/vomiting
  3. POOP – constipation and diarrhea
  4. PSYCH – anxiety, agitation and delirium
  5. PULMONARY – shortness of breath, dyspnea

In addition to the 5 P\’s of Hospice, medications that manage symptoms (not the cause) of the terminal diagnosis are covered. For example, blood pressure medications are covered in cardiac patients but not the maintenance of pacemakers. Another example is that corticosteroids to shrink tumor burden are covered but not chemotherapy.

By | 2018-01-04T19:45:35+00:00 June 1st, 2016|Pharmacist Corner|0 Comments

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