Medicare Coverage for off Label Prescriptions


Medicare part D is supposed cover drugs for off label use if prescribed by your doctor as safe and effective. But in many cases, people who need medications for off label uses are wrongly denied.

First, let's explain what off label drug use is. Your doctor may prescribe a drug for a use that is not specifically approved by the FDA and listed on the label. For example, certain drugs have proven effective for treating cancer, pain, psychiatric problems, multiple sclerosis, and autoimmune diseases, even though the drug was not specifically created for that purpose. Consequently, doctors will prescribe them.

Medicare should pay for drugs used for off label use if the drug is safe and effective for that use. But there's a problem. The problem is that you have the responsibility of proving that the drug is safe and effective for the intended use. Medicare says you can use any one of three medical encyclopedias to prove that. The three approved books are:

* The American Hospital Formulary Service- Drug Information.

*The United States Pharmacopeia-National Formulary.

*The Drugdex Information System.

The answer should be that you could just go to the bookstore or library, and get the book. But, here's where the problem comes in. These three compendia are very tough to get hold of. To buy one, the cost will be hundreds of dollars. And most libraries don't carry one or more of them. Even the library at the national institute of health in maryland doesn't have all three.

So even though the law gives you the right to get coverage for off label use of drugs, they make it very hard to enforce your right.

Off label use of a drug prescribed by your doctor can be a life saver. And congress promised to provide coverage under Medicare part D, as long as the use is safe and effective. But it's very tough to get the information you need to prove your right to coverage. Contact your member of Congress and ask them to either change the requirements, or make the information in the 3 encyclopedias more easily available.

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