Medications Reported to the Medicare Hospice Program after Medicare Drug Policy Changes, 2014-2018

In 2014, Medicare hospice policy changed to shift medication payments from Part D to the hospice benefit.

To describe patterns of medications reported to the Medicare hospice benefit after the 2014 policy change.

Repeated cross-sectional analysis of medications reported to the Medicare hospice benefit between 2014 and 2018. Data sources include the Medicare Master Beneficiary Summary File and national revenue center claims submissions by Medicare-certified hospices. Main outcome measures by year were the mean number of overall and chronic disease medication dispensing per enrollee, the most common medications billed to the Medicare hospice program, and the proportion of medications for end-of-life, chronic diseases, and potentially inappropriate by Screening Tool of Older Persons Prescriptions in Frail criteria.

Between 2014 and 2015, the mean number of dispensings per enrollee covered by hospice temporarily increased from 12.1 (standard deviation (SD) 21.5) to 12.4 (SD 23.4) (P<.001) and returned to 12.1 (SD 23.0) in 2016, while the mean number of chronic disease medication dispensings per enrollee increased from 2.8 (SD 2.2) to 3.2. (SD 2.4) (P<.001) and remained stable. Between 2014 and 2018, the proportion of the top 100 drugs covered by hospice that were for chronic disease or met STOPPFrail criteria remained stable, while the proportion of EOL drugs declined temporarily before returning to 2014 levels.

The Medicare hospice program experienced small but statistically significant increases in chronic disease dispensings per enrollee after 2014 policy changes. Whether these were clinically significant or impacted patient outcomes requires further study.