Medicare Coverage Restricts Off-label Cancer Treatment

Oncology drugs are frequently used off-label, but reimbursement can be tricky. A recent study presented at the Association of Community Cancer Centers (ACCC) 2005 National Oncology Economics Conference showed that a noteworthy percentage of oncologists alter their cancer treatment plans as a result of coverage limitations placed on off-label drug use. These results challenge optimism regarding the Centers for Medicare & Medicaid Services (CMS) press release, Medicare Launches Effort to Improve Cancer Care, which proclaims the expansion of efforts to increase access to care through evidence-based coverage using clinical data. The study concludes that further research is needed to determine how Medicare reimbursement policies may impact access to off-label drug use in cancer care. Christian G. Downs, JD, MHA, executive director of ACCC, told Practice Manager Insider, “The most important aspect of off-label drug use, whether we are speaking about deemed compendia, or any Medicare proposal, is that oncologists have maximum choice in treating their patients.”

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[Christian]

All,

If you are having particular trouble with an off-label indication let us know at ACCC. We would like to help if we can and also it allows us to keep a record of where there are problems. You can email me or Don Jewler at djewler@accc-cancer.org.

CGD