Drugs and Biologicals Coinsurance

30.1 - Drugs and Biologicals Coinsurance (Rev. 188, Issued: 05-01-14; Effective: 08-04-14; Implementation: 08-04-14) Hospices are to provide all drugs and biologicals for the palliation and management of pain and symptoms of a patient’s terminal illness and related conditions. An individual is liable for a coinsurance payment for each palliative drug and biological prescription furnished by the hospice while the individual is receiving routine home care or continuous home care. The individual is not liable for any coinsurance for hospice- related drugs or biologicals provided while he or she is receiving general inpatient care or respite care. The amount of coinsurance for each prescription approximates 5 percent of the cost of the drug or biological to the hospice, determined in accordance with the drug copayment schedule established by the hospice, except that the amount of coinsurance for each prescription may not exceed $5.00. The cost of the drug or biological may not exceed what a prudent buyer would pay in similar circumstances. The drug copayment schedule must be periodically reviewed for reasonableness and approved by the A/B MAC (HHH) before it is used.