For your consideration
Overview of the Most Recent Medications to Treat Diabetes (2015-2020)
Most of the oral medications to treat Type II Diabetes in this group are long-acting and/or combinations. Many patients who become eligible for hospice and have diabetes are often experiencing significant decline in dietary intake for a variety of reasons. They may also come to hospice on long-acting diabetic medications. With tight glycemic control these patients are at greater risk for hypoglycemia and should be comprehensively assessed for the need to remain on these formulations. If these patients do need blood sugar control immediate release insulin is recommended. Prices below are approximate retail.
Oral Formulations (per month cost)
- Xigduo XR (dapagliflozin/metformin) 24 hour extended release tablet = $600
- Synjardy XR (empagliflozin/metformin) 24 hour extended release tablet = $325
- Glyxambi (empagliflozin/linagliptin) once daily tablet = $660
- Steglujan (ertugliflozin/sitagliptin) once daily tablet = $650
- Segluromet (ertugliflozin/metformin) once daily tablet = $180
- Steglatro (ertugliflozin) once daily tablet = $350
Injectable Formulations (per month cost)
- Tresiba (degludec) once daily injection = $1800
- Basaglar (glargine) once daily injection = $775
- Toujeo (glargine) once daily injection = $900
- Xultophy (degludec/liraglutide) once daily injection = $2600
- Soliqua (glargine/lixisenatide) once daily injection = $1750
- Ozempic (semaglutide) once weekly injection = $975
- Adlyxin (lixisenatide) once daily injection = $700
Regulatory Center
Hospice Visits When Death is Imminent (HVWDII) – CMS Proposed Changes
At the end of October Medicare (CMS) published a report focused on visits received by hospice patients in the last week of life.
They looked at two measures:
1. Visits by the registered nurse (RN) and physician.
2. Visits by the medical social worker (MSW), chaplain, LPN and home aide.
CMS looked at the correlation between visits from individual disciplines and each CAHPS quality measure.
Measure 1 showed a positive correlation with the CHAPS quality measure but Measure 2 showed a negative correlation suggesting that these visits in that last week of life were associated with poorer caregiver reported experiences.
As a result of these measures CMS is planning to re-specify the HVWDII measure and achieve improved testing results. CMS has chosen to proceed with the development of hospice visits by RN or MSW in at least 2 of the last 3 days of life quality measure. This measure will be designated “Hospice Visits in the Last Day of Life” (HVLDL).
The written comment period for this proposed change is until November 23rd.
Monitoring Will Continue
Although the changes to the hospice election statement and the inclusion of the addendum were implemented on October 1st, NHPCO and NAHC continue to have dialogue with CMS about both these documents. NHPCO and NAHC anticipate there will be further changes to these documents, especially to the addendum, in the coming months. We will monitor these discussions and post any changes of which we are made aware in this newsletter.
Updated
Drug Shortage List
These shortages are due either from manufacturing delays or shortage of raw ingredients. This is not an inclusive list, but the listed drugs may be used for hospice patients, especially in the inpatient setting. For a complete list of drugs on shortage follow this link:
https://www.drugs.com/drug-shortages/
The FDA is warning that there may be an increase in drug shortages due to the effect the coronavirus is having on raw products coming out of China and India used in the manufacturing of drugs.
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About the Author
David Bougher
Senior VP of Regulatory Affairs
David is a seasoned veteran of the hospice world and an essential member of the Wise Hospice Options clinical team.
Education:
RN, BSN
Experience:
- Former hospice COO
- 20 Years of education & training experience
- 10 Years of experience at Wise Hospice Options
Connect
- (800) 856-9757 Ext: 203
- dbougher@wiseop.com
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Vice President
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