tci Medicare Compliance & Reimbursement - 2007 Issue 32

PART D: Off-Label Coverage War Heats Up

Pharmacists' role: Know when exceptions and appeals could help.A new report slamming the feds for allowing Part D denials for "off-label" prescriptions could be just what you need ...quot; new fuel in the fight to get clients the drugs that they require.The study, released Aug. 2 by the Medicare Rights Center, charges that Medicare beneficiaries are being denied Part D coverage for prescription drugs that are medically appropriate but "off-label." The report contends that a regulation issued by the Bush administration last year misinterprets statute. That misinterpretation in turn opened the door for prescription drug plans...

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