Yes, hospice provides medications for pain relief and symptom management as part of its core services. Under the Medicare Hospice Benefit, these medications come at little to no cost to the patient, with a maximum copay of $5 per prescription. Hospice teams prescribe, deliver, and guide the use of drugs that keep patients comfortable, but the specific medications covered depend on whether they’re related to the terminal diagnosis.
What Hospice Covers and What It Doesn’t
Hospice focuses exclusively on comfort. That means it covers medications that control pain, ease breathing, reduce nausea, manage anxiety, or address any other symptom tied to the terminal illness. It does not cover medications intended to cure the illness or prolong life. For example, a patient with terminal lung cancer would receive pain medications and anti-nausea drugs through hospice, but chemotherapy would not be part of the plan.
Medications for conditions unrelated to the terminal diagnosis, like blood pressure pills or thyroid medication, fall outside the hospice benefit. In those cases, the hospice team should let you know so you can check whether Medicare Part D or another insurance plan still covers them. You can also ask your hospice provider for a written list of which drugs they consider unrelated to the terminal illness.
For medications that are covered, Medicare patients pay nothing for hospice care itself and no more than $5 per prescription for outpatient drugs used at home for pain and symptom control.
Common Medications Used in Hospice
The most frequently prescribed hospice medications target a handful of overlapping symptoms: pain, nausea, anxiety, agitation, and difficulty breathing. Morphine is the cornerstone for moderate to severe pain and shortness of breath. Oxycodone and fentanyl patches serve as alternatives depending on the patient’s needs and tolerance. For milder pain or fever, acetaminophen is standard.
Beyond pain control, hospice teams commonly prescribe haloperidol for nausea, vomiting, and the restlessness that can occur near the end of life (sometimes called terminal agitation). Lorazepam helps with anxiety and seizures. Prochlorperazine treats nausea. A steroid called dexamethasone can reduce swelling, ease nausea, and relieve certain types of pain. For the rattling breathing sound caused by fluid buildup in the throat, medications that dry secretions (like atropine) are used, though evidence on their effectiveness is limited.
The Comfort Kit
Most hospice agencies send a small kit of emergency medications to the patient’s home at the time of admission. This is often called a “comfort kit” or “e-kit,” and it’s designed so caregivers have fast access to relief when symptoms flare outside of regular visits. A typical comfort kit contains:
- Morphine liquid for pain or breathing difficulty
- Lorazepam liquid for anxiety or agitation
- Haloperidol liquid for nausea or confusion
- Atropine drops for excessive secretions
- Acetaminophen suppository for fever or mild pain
- Prochlorperazine suppository for nausea
- Bisacodyl suppository for constipation (a common side effect of opioids)
These medications are kept in the home and used only when the hospice nurse instructs the caregiver to give them, usually by phone. The kit exists so that a patient doesn’t have to wait hours for a nurse to arrive or make a trip to the pharmacy in the middle of the night.
Who Actually Gives the Medications
In home hospice, the family caregiver is typically the person physically administering medications day to day. Over 80% of family caregivers report managing medications for hospice patients. The hospice nurse visits regularly (usually several times a week, more often as needs increase) to assess symptoms, adjust doses, and teach caregivers how to give each drug safely. But between visits, the caregiver handles it.
This can feel intimidating, especially with opioids. Hospice providers emphasize technical skills like giving the right dose at the right time and understanding the difference between scheduled doses and “as needed” doses. One important rule: never crush extended-release tablets, which are designed to release medication slowly and can cause a dangerous overdose if broken apart.
Some caregivers misunderstand the comfort kit’s purpose and assume the nurse will come to administer those medications. In reality, the kit is there specifically so caregivers can provide relief quickly with phone guidance from the hospice team. If you’re a caregiver, ask your hospice nurse to walk you through each medication in the kit before you need it. Less than 60% of family caregivers report receiving hands-on medication management help from their hospice, so being proactive about training makes a real difference.
In inpatient hospice settings (a hospice facility or hospital), nurses handle all medication administration directly.
How Medications Are Given When Swallowing Gets Difficult
As patients get closer to the end of life, swallowing pills often becomes impossible. Up to 70% of patients eventually need a non-oral route for pain medication. This is one reason many comfort kit medications come as liquids or suppositories rather than pills.
Liquid morphine and lorazepam can be placed under the tongue or along the inside of the cheek, where they absorb through the tissue without needing to be swallowed. Fentanyl patches deliver pain medication through the skin continuously. Suppositories bypass the mouth entirely. For patients in an inpatient setting or with more complex needs, medications can also be given through a small needle placed just under the skin or through an IV line.
What Happens to Leftover Medications
After a patient passes away, unused controlled substances like opioids need to be disposed of properly. Since 2018, federal law allows qualified hospice employees to collect and destroy unused controlled substances in the patient’s home. Best practices include having a witness present during disposal and conducting prescription drug counts during the care period to make sure medications are being used appropriately.
In practice, the process varies. Some hospice programs handle disposal directly during a bereavement visit. Others still rely on educating family members about how to dispose of the drugs themselves, particularly in states where local laws haven’t caught up with the federal rule. If your hospice doesn’t offer to dispose of medications, you can use drug take-back programs or follow FDA guidelines for flushing certain opioids. Hospice agencies may also use lockboxes during the care period if there are concerns about unauthorized access to controlled substances in the home.