Hospice Pharmacy Services: What Comfort Care Teams Should Look for in a Partner

Hospice teams work in a time-sensitive environment. When pain, anxiety, nausea, shortness of breath, or other symptoms change, patients and families need help quickly. Nurses need reliable access to medications, clear communication, and a pharmacy partner that understands the pace and priorities of end-of-life care.

That need is becoming more important as the hospice census grows. According to the Medicare Payment Advisory Commission, approximately 1.82 million Medicare beneficiaries received hospice services in 2024, representing a 4.6% increase from the previous year. About 52.9% of Medicare decedents received hospice services that year. Read the 2026 MedPAC report.

For hospice and long-term care leaders, the right pharmacy relationship is about more than filling prescriptions. It is about creating a dependable medication system that supports comfort, safety, compliance, and the interdisciplinary team.

What hospice pharmacy services should include

Hospice pharmacy services may include medication dispensing, delivery, packaging, clinical consultation, controlled substance coordination, reporting, and support for after-hours needs. The exact model varies by state, setting, payer, and contract, but a strong partner should be able to explain how each part of the medication process will work.

1. Prompt routine, STAT, and after-hours access

Medication delays can create significant stress for patients, families, nurses, and facility staff. Hospice organizations should look for a partner with clear processes for:

• Routine medication orders and refills
• Urgent or STAT prescriptions
• Nights, weekends, and holidays
• Delivery to homes, assisted living communities, nursing facilities, or hospice inpatient units
• Escalation when a medication cannot be filled as originally ordered
• Communication with the hospice nurse or designated after-hours team

Federal hospice requirements call for drugs and biologicals to be routinely available on a 24-hour basis, seven days a week. Hospices may meet this responsibility through their own systems, contracted pharmacies, local pharmacy networks, or a combination of resources. See CMS hospice guidance.

A pharmacy partner should be able to describe what happens after a routine business-hour workflow ends. Who receives the order? Who contacts the prescriber if clarification is needed? How is delivery tracked? What happens if the first delivery attempt is unsuccessful?

These details matter because after-hours staff often have fewer resources and fewer options. A clear pharmacy process can help prevent avoidable calls, delays, and emergency department transfers.

2. Hospice-appropriate medication packaging

Packaging should make medication administration easier and safer for the people providing care. Depending on the patient’s needs and the care setting, useful options may include:

• Unit-dose or patient-specific packaging
• Clearly labeled medication cards or blister packs
• Packaging organized by administration time
• Liquid medication containers with appropriate labeling
• Refill synchronization
• Packaging that supports medication reconciliation
• Separate handling and documentation for controlled substances

In a long-term care or assisted living setting, packaging can reduce the amount of time nurses spend sorting medications and resolving labeling questions. In home hospice, clear packaging can also help caregivers understand which medication is intended for which purpose when they are instructed by a hospice clinician.

Packaging is not a replacement for clinical direction. Families and caregivers should follow the hospice plan of care and speak with the hospice nurse or prescriber before administering medications, especially medications used for pain, anxiety, agitation, or breathing-related symptoms.

3. Comfort kits and hospice-appropriate supplies

Many hospice programs use comfort kits, sometimes called emergency medication kits, to help address common symptom needs before a routine prescription delivery can arrive. Contents vary by hospice protocol and patient circumstances, but may address symptoms such as:

• Pain
• Shortness of breath
• Anxiety or restlessness
• Nausea
• Fever
• Constipation
• Terminal secretions

A comfort kit should be treated as part of a coordinated clinical process. The hospice team determines what is appropriate, the prescriber authorizes the medications, and the patient or caregiver receives instructions about when and how to use them.

CMS does not require one specific comfort-kit format or set of medications. Hospices must instead maintain a compliant system for timely access to drugs and biologicals. Comfort kits must also follow applicable state pharmacy laws, prescribing requirements, storage rules, labeling standards, and billing procedures. Review Medicare’s hospice benefit information.

When evaluating a pharmacy, ask:

• Can comfort kits be customized to the hospice’s protocols?
• How quickly are kits prepared and delivered?
• How are kits restocked?
• How are expired or unused medications handled?
• How are comfort-kit medications documented and billed?
• Can the pharmacy support both home hospice and facility-based care?

4. Controlled substance coordination

Controlled substances are an important part of comfort-focused care, but they also require careful handling. A pharmacy partner should have clear procedures for prescribing, dispensing, delivery, storage, documentation, reconciliation, and disposal.

Hospice leaders should ask how the pharmacy supports:

• Electronic prescribing for controlled medications
• Partial fills and remaining quantities
• Schedule II medication coordination
• Secure delivery and receipt documentation
• Communication between the pharmacy, hospice, facility, and prescriber
• Medication changes or discontinuations
• Unused medication and disposal documentation

Requirements may differ by state. For example, Virginia regulations address 24-hour emergency services, individualized labeling, pharmacist consultation, medication review, and notification requirements related to certain Schedule II controlled substances. See Virginia’s hospice pharmacy services regulations.

A dependable pharmacy does not replace the hospice’s compliance program. It should, however, make the required processes easier to follow and document.

How the right partner supports the interdisciplinary team

Hospice care depends on collaboration among nurses, physicians, pharmacists, social workers, chaplains, aides, facility staff, patients, and families. Pharmacy support should fit into that team rather than create another separate workflow.

A strong partner can help by providing:

Pharmacist access

Hospice-trained or hospice-experienced pharmacists can help answer questions about medication availability, dosage forms, alternatives, interactions, administration concerns, and deprescribing. This can be especially helpful when a patient’s condition changes quickly or a medication is unavailable.

Medication reconciliation support

Medication lists can change frequently during hospice care. Pharmacy support may help the team identify duplicate therapy, discontinued medications, refill concerns, and differences between the hospice plan of care and facility medication records.

Formulary and cost visibility

Hospice leaders should be able to understand how formulary decisions, delivery fees, non-formulary requests, and patient-specific changes affect total pharmacy costs. Transparent reporting can help organizations manage budgets without making medication access unnecessarily difficult.

Less administrative work for nurses

Every call, fax, clarification, delivery search, and medication-status check takes time away from patient and family care. A dedicated pharmacy workflow should reduce unnecessary back-and-forth through clear ordering processes, accessible support, delivery tracking, and defined escalation paths.

The goal is not simply faster dispensing. The goal is to give nurses and other clinicians more time for assessment, education, symptom management, and emotional support.

Questions to ask when evaluating a hospice pharmacy partner

Before signing an agreement, hospice and long-term care leaders should ask practical questions and request specific answers.

Service and availability

• What services are available during regular hours?
• What happens after hours, on weekends, and on holidays?
• Is there a live person to contact for urgent medication needs?
• What are the expected response and delivery times for STAT orders?
• Which geographic areas and care settings are supported?

Clinical support

• Are pharmacists available for medication questions?
• Do pharmacists understand hospice and comfort-focused care?
• Can the pharmacy participate in medication reviews or interdisciplinary discussions?
• How are medication changes and clinical clarifications communicated?

Packaging and delivery

• What packaging options are available?
• Can medications be organized by patient, dose, or administration time?
• How are deliveries tracked?
• How are failed deliveries, missing packages, or damaged medications handled?
• Can the pharmacy support comfort kits and facility-based emergency medication processes?

Controlled substances and compliance

• How are controlled substances prescribed, delivered, documented, and reconciled?
• What procedures apply to partial fills and discontinued medications?
• How does the pharmacy support applicable federal and state requirements?
• What documentation is available for audits and quality reviews?

Technology and reporting

• Does the pharmacy support electronic prescribing?
• Can hospice and facility teams view order status?
• Are formulary, utilization, delivery, and cost reports available?
• Can the system work with the organization’s existing technology and workflows?

Partnership and growth

• Will the organization have a dedicated account contact?
• How does onboarding work for new locations or a growing census?
• Are references available from similar hospice or long-term care organizations?
• How are service issues reviewed and resolved?

A pharmacy partner should make comfort care easier

Hospice teams should not have to build complicated workarounds to obtain essential medications. The right pharmacy partner helps create a dependable system for ordering, packaging, delivery, after-hours access, controlled substance coordination, and clinical communication.

As the hospice census continues to grow, these systems become even more important. They help protect patient comfort while reducing pressure on nurses, facility staff, prescribers, and after-hours teams.

One Pharmacy supports healthcare organizations and long-term care partners with pharmacy services designed around recurring medication needs and coordinated care. To discuss your hospice or facility pharmacy needs, contact One Pharmacy and speak with our team about building a reliable medication support process for your organization.

Pharmacy services, medication availability, delivery options, packaging, and controlled-substance procedures may vary by location, patient needs, payer requirements, and applicable federal and state law.