Push for off-label Rx coverage by Medicare

The annual registration period for US senior citizens on the Medicare Part D prescription drug benefit (Marketletters passim) has been the opportunity for a number of groups to campaign for reforms to the federal program. A coalition of 26 patient, family caregiver and health professional organizations has called on the US Congress to enact legislation requiring Medicare coverage of off-label use of prescribable medicines.

Medicare Access for Patients Rx has written to the Chairman of the US Senate Finance Committee, Max Baucus (Democrat, Montana), stating that "people with cancer, HIV/AIDS, lupus, multiple sclerosis, debilitating pain, and mental health conditions, and other rare and serious conditions are routinely prescribed drugs off-label to manage disease symptoms and progression." However, under Medicare rules, Part D coverage is limited to either Food and Drug Administration-approved uses or those endorsed by one of three medical compendia.

Nevertheless, more than one in five of the 500 most commonly-prescribed drugs are used for off-label treatments, the MAPRx states. Andrew Sperling, director of legislative advocacy for the National Alliance on Mental Illness, said: "we know of a number of people who have been hospitalized or been required to take other more expensive treatments because they did not have access to their prescribed medicines."