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Old 04-19-2006, 09:04 PM   #2
Lolly
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Join Date: Aug 2001
Location: Oregon
Posts: 1,756
Medicare Coverage of "Off Label" Drugs

Apparently it's true, here's an excerpt from NCA's web site:


"...The U.S. Congress passed a law in 1993 requiring Medicare (http://www.medicare.gov/), the federally funded health care program for elderly and disabled people, to cover off-label drugs used in cancer treatment when the use is supported by:

1. A citation in at least one of the following authoritative drug reference books.

2. The American Society of Health-System Pharmacists' American Hospital Formulary Service (AHFS). There is a regularly updated online version.

U.S. Pharmacopeia Drug Information

3. Two or more peer-reviewed articles published in respected medical journals.


Medicare coverage policy is not binding on private health insurance providers, although some insurers have adopted coverage policies consistent with Medicare's. Many states have passed laws or issued regulations requiring state-regulated private health insurers to provide coverage similar to Medicare's for off-label drug use in cancer treatment. However, organizations (usually large companies) funding their own health insurance coverage are exempt from these state laws and regulations, although many comply voluntarily..."



Also, here's a link to an article explaining which off label drugs Medicare/Medicaid will cover under the auspices of a clinical trial.

Medicare's NCD Act
http://www.cancer.gov/clinicaltrials...pments/NCD179N

Last edited by Lolly; 04-19-2006 at 09:14 PM..
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