HOSPICE APPROVED MEDICATIONS Page 1 of 4
High Peaks Hospice & Palliative Care, Inc. (HPH&PC) has developed a formulary of drugs that are appropriate for managing pain and symptoms related to the terminal illness. The drugs listed are considered preferred drugs for hospice use. HPH&PC pays for medications related to the hospice diagnosis and for pain and symptom management for the terminal illness. Non-formulary drugs are considered for patients who fail with formulary drugs or for whom formulary drugs are contraindicated. Over the counter, non-prescription medications may be ordered, but are not approved for HPH&PC payment unless they are related to the hospice diagnosis.
Before approving a drug for reimbursement by HPH&PC, the following utilization review should be conducted:
• Medication the patient is currently taking
• Drugs initiated since terminal illness
• Appropriate therapy for this stage of patient’s illness
All medications approved for HPH&PC will be reviewed at the 48 hour admission review and at each IDT for appropriateness for hospice.
Medications approved for hospice use have up to a thirty day maximum supply given at a time.
HOSPICE APPROVED MEDICATIONS FORMULARY OF PREFERRED DRUGS LISTED BY SYMPTOMS Analgesics Non-Opioid
Ibuprofen (Motrin) Naproxen (Naproysn) Calecoxib (Celebrex) Rofecoxib (Vioxx) Prednisone Dexamethasone (Decadron) Amitriptyline (Elavil) Nortriptyline Carbamezepine (Tegretol) Gabapentin (Neurontin) Clonazepam (Klonopin)
Hyrocodone + APAP Oxycodone + APAP Codeine Codeine + APAP Propoxyphene/NAP/APAP Oxycodone (Oxycontin) Morphine Fentanyl (Duragesic, Sublimaze, Actiq) Hydromorphone (Dilaudid) Methadone
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