Illuminations

Shedding light on hospice pharmacy.

Perspectives on the technology gaps, the misaligned incentives, and what moving forward actually looks like.

Clinical Decision Support·October 13, 2026

When a Medication Outlives Its Purpose

Deprescribing is good hospice care first. It also happens to be the one medication decision that eases pressure from two directions at once, and the hard part was never spotting the opportunity.

Accountability·October 8, 2026

The SSVI, Sorted: What 6,673 Scores Show About Size, Ownership, and Noise

CMS publishes hospice size in four coarse categories that stop at 68 census, so we rebuilt actual size from CMS's own file and sorted all 6,673 SSVI scores by it. Above 300 census, 98% of hospices max out the spending half. The score climbs with census on its own, it hides a gap CMS's own analysis found, and nearly one in five hospices swung three points in a year.

Accountability·October 6, 2026

You Understand the FY27 Rule. Now How Do You Operationalize It?

After walking hospice leaders through the FY 2027 changes, the question that mattered wasn't what the rule says. It was how to operationalize it. The answer is narrower than three compliance projects, and it comes down to medication coverage.

Accountability·September 8, 2026

What a 30-Day Implementation Actually Looks Like

What keeps a hospice on a platform it has outgrown usually isn't the software. It's the fear of switching. Here is what a bounded, guided go-live actually looks like, and why the risk is smaller than the horror stories.

Accountability·September 1, 2026

Half Your SSVI Score Is One Number. Here's What's Actually In It.

CMS has reduced every hospice to a single number between 0 and 16. Half of it is one measure scored on unadjusted total dollars, a big share of it flags hospices by construction, and it swings year to year. How to read your SSVI honestly, and the one part of it worth acting on.

Pharmacy Partnerships·August 25, 2026

Where the New Hospice Metrics Are Won: The Pharmacy Relationship

Half of the new hospice service and spending variation index is non-hospice spending, and a real part of it is decided at a pharmacy counter you don't staff. Why the score is a network-friction problem, not a documentation problem, and how preventing rejections is the lever.

Clinical Decision Support·August 18, 2026

The Call You Make at Admission Comes Back Four Times

The relatedness determination made on a hospice admission medication profile is read by a pharmacy, a family, a Part D plan, and CMS, each on a different clock. What the determination has to survive, and why the first pass is worth more than the corrections.

Clinical Decision Support·August 11, 2026

The Addendum Is No Longer on Request. It's Every Admission.

For elections beginning October 1st, the hospice non-covered items addendum becomes mandatory, with a five-day clock and a written explanation a family can follow. The volume is the smaller problem. The bigger one is that the determination becomes a written commitment before most hospices have assembled what they need to make it.

Clinical Decision Support·August 4, 2026

The Prescriber's Perspective: What Clinicians Actually Need On-Screen

A prescribing screen either helps a clinician decide or gets in the way. The two ways it fails, why good decision support is subtractive, and how MerlinRx surfaces what a hospice prescriber needs in the workflow instead of burying it.

Modern Technology·July 28, 2026

What Does 'Real-Time' Actually Mean in Hospice Pharmacy?

Every hospice pharmacy vendor says real-time. Here is the test that separates a real-time answer from real-time data, and what MerlinRx means by it: coverage, contract price, and prior authorization status on the prescribing screen, before the prescription goes out.

Pharmacy Partnerships·July 21, 2026

What Pass-Through Pricing Actually Means (With Numbers)

Pass-through pricing finally shows you what the drug cost, and that matters. But a fee charged per claim, per prior authorization, or per clinical call keeps a vendor earning more the more you process. True transparency is a fee that does not pay the vendor to do more to you: a worked example of spread, per-claim, and per-patient-day pricing.

Pharmacy Partnerships·July 14, 2026

Hospice Formulary Management: The List That Decides for You

Your hospice formulary is supposed to govern every prescribing choice, every substitution, every coverage rule. In most arrangements it lives outside the workflow, in a PDF or an email, and the pharmacy is the first to learn a prescriber made a choice against it. What changes when the formulary shows up where the work happens.

Clinical Decision Support·July 7, 2026

The Line Item That Isn't on the Invoice

Your pharmacy invoice shows drug spend and hides the largest cost of the old model: your team's time. How to put an honest, illustrative number on the hours lost to rejections, prior authorizations, and hold time, and why a vendor optimizing the visible line has no reason to shrink the invisible one.

Modern Technology·June 30, 2026

Prescribing Should Be the Easy Part

In most hospice setups, ePrescribing became one more system to log into, and the friction quietly degrades oversight. What it looks like when prescribing collapses back into the workflow: a queue the prescriber can sign in bulk, delegation with real visibility, and EPCS that gates only what must be gated.

Clinical Decision Support·June 24, 2026

What to Ask a Hospice Pharmacy Vendor, Whether or Not You Run an RFP

Formal RFPs and informal evaluations fail the same way: the questions come from the incumbent's last proposal, so every vendor passes. The questions that work are organized by what each answer reveals: pricing incentives, formulary governance, the prescribing moment, daily operations, and the exit.

Accountability·June 23, 2026

5 Questions to Ask Any Hospice Pharmacy Vendor (Including Us)

Five questions that expose any hospice pharmacy vendor's model: ownership, pricing, timing, measurement, and exit. For each one: why it matters, what a strong answer sounds like, the red flag to listen for, and our own answer on the record.

Accountability·June 16, 2026

What If Your Pharmacy Platform Measured Its Own Impact?

Most hospices evaluate their pharmacy vendor on invoices and anecdotes, because that is all the vendor provides. Accountability looks different: a baseline before go-live, the same numbers after, and a vendor that stakes the relationship on the difference.

Accountability·June 12, 2026

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