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Medicare Widens Options for Off-Label Drug Use

POLICY

Policy change improves treatment reimbursment

Following a change in ledicare policy, insurers and formulary committees have a wider pool of resources from which to base their coverage decisions regarding off-label uses of drugs. The policy applies specifically to off-label uses of cancer therapies administered by physicians under Medicare Part B. But by granting official status to new reference publications, the Medicare policy is expected to carry over to the Part D drug benefit, as well as to private plans and payers.

Health plans, employers, and pharmacy benefit managers generally cover drugs for indications listed on the product's label, as approved by FDA. However, the ...

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