Coinsurance on Outpatient Drugs and Biologicals

70.2 - Coinsurance on Outpatient Drugs and Biologicals (Rev. 1, 10-01-03) The hospice may charge the beneficiary a coinsurance amount equal to 5 percent of the reasonable cost of the drug or biological to the hospice, but not more than $5, for each prescription furnished on an outpatient basis. The hospice is not required to make this charge but may do so in accordance with the following. • The hospice must establish a “drug copayment schedule” that specifies each drug and the copayment to be charged. The copayment charges included on the schedule must approximate 5 percent of the cost of the drugs or biologicals to the hospice, up to a $5 maximum. Additionally, the cost of the drug or biological may not exceed what a prudent buyer would pay in similar circumstances. The hospice must submit this schedule to the A/B MAC (HHH) in advance for approval.