Hospice Medication Management

A standard hospice comfort kit typically includes a short-acting opioid (often liquid morphine sulfate) for pain and dyspnea, a benzodiazepine (often lorazepam) for anxiety and agitation, an antiemetic (often haloperidol or prochlorperazine) for nausea, an anticholinergic (often atropine or scopolamine) for terminal secretions, and an antipyretic (often acetaminophen). Agency-specific kits may add a topical lidocaine, a constipation regimen, or a glycopyrrolate alternative. The kit is delivered on admission and kept in the home for symptom management.

Under hospice rules, the hospice agency must cover medications related to the patient's certified terminal diagnosis and the related conditions noted on the certification. Medications for unrelated conditions (for example, a long-term blood pressure medication for a patient certified for terminal cancer) are typically the patient's responsibility under their non-hospice Medicare Part D benefit. The hospice medical director makes the related vs unrelated determination for each medication, and our team documents the decision in the chart and routes any patient or family billing communication.

The hospice pharmacy benefit covers medications related to the terminal diagnosis and the related conditions on the certification. Coverage is administered through a hospice pharmacy benefit manager (PBM) such as Enclara, Optum Hospice, or HospiScript. The PBM provides a formulary, mail-order delivery, and emergency local pharmacy fulfillment. Our team coordinates daily with the PBM for prior authorizations, refill orders, and any formulary exceptions ordered by the hospice medical director.

After a patient death, any Schedule II to V controlled substances remaining in the home must be disposed of per DEA guidance and state law. The most common protocol is destruction by an RN or hospice staff member at the home, with a witness, using a disposal kit or a documented water-and-coffee-grounds method. The disposal is logged with date, time, witness name, medication name, quantity, and method. The record goes in the chart. State-specific variations (for example, Florida and California have stricter rules) are honored.

Every medication administered to the patient is logged in the medication administration record (MAR) with date, time, dose, route, administering clinician or trained family caregiver, and patient response for PRN doses. The MAR is verified daily against the active physician order. Discrepancies (a dose given without an order, an order without an administration, or a dose given outside the ordered window) are flagged for immediate RN case manager review. PRN medication use patterns are summarized for every 15-day IDG meeting.

Family caregivers receive education on each medication at the time of first administration: drug name, indication, dose, route, frequency, side effects to watch for, and when to call the on-call nurse. Education is documented with date, family member name, and a teach-back result (the family member explains the medication back in their own words). Families who signal uncertainty or refuse a medication trigger an RN follow-up visit and a plan-of-care update.

Per-FTE weekly pricing. $399 per week per FTE for a standard single-site hospice agency. $349 per week per FTE for the popular volume tier (3 or more FTEs across medication management, IDG, and intake). $299 per week per FTE for an enterprise hospice network with 10 or more FTEs. No setup fees. No annual contracts.

You get 14 days of live medication management at the same per-FTE weekly rate. We order comfort kits, route related vs unrelated reviews, coordinate the hospice PBM, audit MARs, and document post-death controlled substance disposal. At the end of day 14 you decide go or no-go. Cancel before day 14, owe nothing. No annual contract after.