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Letter to Marilyn Tavenner, Administrator of the Centers for Medicare & Medicaid Services - Medicare Part D Policy

The Honorable Marilyn Tavenner
Centers for Medicare & Medicaid Services
Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201

Dear Administrator Tavenner:

We write to you today to express our concern that the policy articulated in the Center for Medicare & Medicaid Services' "Part D Payment for Drugs for Beneficiaries Enrolled in Hospice -- Final 2014 Guidance" (Guidance) could jeopardize hospice patients' timely access to needed medications.

While well-intentioned, the prior authorization process you have established for the medications of Part D beneficiaries who have elected hospice could result in delayed access to medication for a population that, by very definition, does not have time to spare. At a minimum, this Guidance has resulted in confusion among both providers and patients. While this confusion is sorted out, it is imperative that care for Medicare beneficiaries at the end of life not be negatively impacted.

For this reason, we ask that CMS immediately suspend the Guidance and begin a process to develop an alternative approach which will ensure both that the right individual or entity pays for the hospice patient's medications and that the patient get the medication that he or she requires without interruption. Ideally, CMS would gather all relevant stakeholders, including beneficiary advocates, hospice providers, Part D plans and pharmacists, to collectively work through these issues. Any revised guidance should take into account the patient's individualized hospice care plan as well as the clinical recommendations of their health care professionals.

We appreciate your agency's effort to protect taxpayer dollars by making sure that Medicare is not paying double for prescription drugs for beneficiaries who have elected hospice. However, any efforts to address this concern with hospice providers and the Medicare Part D plans cannot be done at the expense of vulnerable patients seeking end of life care. Thank you in advance for your prompt attention to this matter.

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