Scramble or script: responding to new Medicare billing for medications in hospice.
Scramble or script: responding to new Medicare billing for medications in hospice.
复制标题
混乱或脚本：响应新的医疗保险临终关怀药物账单。
DOI：
10.1089/jpm.2014.0230
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发表时间：
2014
影响因子：
2.8
通讯作者：
Ellington,Lee
中科院分区：
文献类型：
--
作者：
Tjia,Jennifer;Talebreza,Shaida;Reblin,Maija;Beck,Anna;Ellington,Lee
亲爱的编辑：2014年3月，医疗保险和医疗补助服务中心（CMS）的临终关怀药物账单指南发生了变化。该指南要求临终关怀不提供的所有处方药都必须获得医疗机构的事先授权（PA），以确定这些药物是否可以在Medicare Part D中承保。1临终关怀受益人的药物保险将被视为“不寻常和特殊情况”。临终关怀提供者以及他们所服务的病人和家属都争先恐后地遵守PA的要求。人们对获得必要药物的障碍和患者/家庭可能的不适当费用提出了担忧。经过三个月的混乱，CMS与临终关怀提供者协商修改了指南，放宽了PA要求，仅包括四类药物“几乎总是在临终关怀福利中被确定为”：“镇痛药，止吐药，泻药和抗焦虑药。[2]虽然这一最新的变化使人们不再需要突然决定是否在临终关怀中开慢性病药物，但仍然存在阻碍临床护理、生活质量和家庭支出的问题。
Dear Editor: Turmoil ensued in March 2014 with changes to the Center for Medicare and Medicaid Services (CMS) hospice medication billing guidance. The guidance required beneficiary-level prior authorization (PA) for all prescription medications not provided by hospice to determine whether these medications would be coverable under Medicare Part D. 1 Medication coverage for hospice beneficiaries would be considered an ‘‘unusual and exceptional circumstance.’’Both hospice providers and the patients and families they served scrambled to adhere to PA requirements. Concerns were raised about barriers in accessing necessary medications and potential inappropriate costs to patients/families.After three months of confusion, CMS revised guidance in consultation with hospice providers to relax PA requirements to include only four classes of drugs ‘‘identified as nearly always covered under the hospice benefit:’’analgesics, antinauseants, laxatives, and antianxiety drugs. 2 While this latest change provides some reprise from abruptly needing to decide whether to prescribe or discontinue chronic disease medications in hospice, problems remain that hinder clinical care, quality of life, and expenditures for families.