Hospice Pharmacy Insights Q4 2020

New This Month: Covid-19 & COPD Management, Consensi & Qutenza, Medical Reviews & the Emergence of ADRs, & an Updated Drug Shortage List.
For your consideration

Covid-19 & COPD Management

As COVID-19 has affected over 5 million US citizens our patients and families have not been spared. Our patients are at high risk as a result of their disease process, comorbidities, age and frailty. This is especially true of our COPD patients.

Prior to COVID-19 our recommendations for inhalation therapy centered around the nebulized Beta₂ agonists (albuterol), anticholinergics (ipratropium) and corticosteroids (budesonide). However, nebulizers are associated with aerosolization, potentially increasing the risk of COVID-19 transmission, in patients with suspected or documented COVID-19. Current recommendations are that inhaled medications should be administered via metered dose inhalers, where possible.

It is also recommended that if a nebulizer must be used, appropriate infection control precautions should be taken by caregivers to include N-95 masks, goggles & gowns. Non-essential people should leave the room and NOT re-enter for 2-3 hours after nebulization.

Below is a list of some of the current respiratory meds available in metered dose inhaler formulation:

Medication Drug Class Approx Monthly Cost (Retail)
Albuterol (Proair) Beta₂-agonist $50
Ipratropium (Atrovent) Anticholinergic $520
Budesonide (Pulmicort) Corticosteroid $300
Fluticasone/Salmeterol (Advair) Beta₂/Corticosteroid $399
Aclidinium (Tudorza) Anticholinergic $690
Glycopyrrolate (Seebri Neohaler) Anticholinergic $475
Indacaterol (Arcapta) Beta₂ $310
Olodaterol (Striverdi Respimat) Beta₂ $275
Revefenasin (Yupelri) Anticholinergic $1,300
Salmeterol (Serevent) Beta₂ $520
Tiotropium (Spiriva) Anticholinergic $550
Umeclidinium (Incruse Ellipta) Anticholinergic $420
Fluticasone/Umeclidinium/Vilanterol (Trelegy Ellipta) Anticholinergic/Beta₂/Corticosteroid $690

The above is not an inclusive list, there are many more and many in long-acting combinations.

In case you were wondering

Consensi (amlodipine and celecoxib)

This is an interesting combination of a calcium channel blocker and NSAID used to treat the pain associated with osteoarthritis and hypertension. The pain is controlled by reducing inflammation and relaxing blood vessels.

Available doses are 2.5mg/200mg, 5mg/200mg and 10mg/200mg. Initial dosing is 2.5mg/200mg once daily. May titrate every 1-2 weeks as needed based on blood pressure. Cost (retail) is $1100-$1500/month depending on dose.

Qutenza (capsaisin transdermal)

This transdermal patch contains prescription strength capsaisin 8%. It is indicated for postherpetic neuralgia and diabetic peripheral neuropathy. The patch is applied for 1 hour and may relieve pain for up to 3 months. The patch must be applied by a health care provider (i.e., physician, nurse, etc) who is familiar with the proper application, removal and disposal of the patch.

Approximate retail price per patch is $885.

Regulatory Center

Medical Reviews and the Emergence of ADRs

In our August newsletter we wrote that CMS was going to discontinue exercising enforcement discretion as of August 3, 2020. Additional Documentation Requests (ADR) are beginning to appear and there is no indication that the public health emergency will inhibit medical reviews going forward.

On August 21st Palmetto and CGS issued guidance regarding medical review. NGS has not posted its information to its website at the time of this newsletter.

Palmetto’s medical review for hospice services will be focused on medical necessity for General Inpatient Services for care over seven or more days with Revenue Code 656 and a Place of Service between Q5004 and Q5009.

CGS’ medical review for hospice services will follow home health medical review and CGS will post information when reviews are slated to begin.

Reminder: Changes to the Hospice Election Statement & Election Statement Addendum go into effect October 1, 2020

NHPCO has just developed an Implementation Toolbox that is available on their website if your hospice is a member.

National Association of Home Care and Hospice made available to their members on August 5, 2020 detailed information final detailed information regarding the election statement addendum.


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:


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.

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. 




  • Former hospice COO
  • 20 Years of education & training experience
  • 10 Years of experience at Wise Hospice Options


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