Below is a press release concerning a bill of great interest to me. It would allow Medicare Part D to cover drugs prescribed by a physician for off-label use. This is particularly interesting to me as someone with an ultra rare genetic disorder. It is so hard to do clinical trials for ultra rare disorders that often our doctors must prescribe drugs to treat our symptoms - even though these may not be our diagnosis. This leaves us sometimes open to insurance companies denying coverage because it's an off-label use. Too often it comes down to how savvy a doc is about paperwork.
While this bill wouldn't require other insurers to do the same, historically the industry is more willing to make changes that were first made by Medicare.
Check it out.
Thornberry Introduces Bipartisan Bill To Let Patients Get the Care They Need
Washington, Mar 18 -
U.S. Representatives Mac Thornberry (R-TX) and Russ Carnahan (D-MO) today announced introduction of the bipartisan Part D Off-Label Prescription Parity Act. The bill, H.R. 1055, would allow Medicare Part D carriers to cover the "off-label" use of drugs prescribed to people living with chronic diseases when its use is supported by experts.
Currently, many Medicare consumers with serious and sometimes life-threatening conditions are unable to access safe and effective medications under Medicare Part D. Only Medicare Part B and Part D medications used to treat cancer, but not other medical conditions, are eligible for coverage.
“Doctors and patients should be able to choose the safest and most effective medications for their treatments,” said Rep. Thornberry. “Right now, the requirements for coverage of the off-label use of a drug are burdensome and often result in Medicare patients not being able to get the drug coverage they need. Our bill helps fix that problem,” continued Thornberry.
The bill would give Part D plans the same flexibility allowed under other parts of the Medicare program and in the commercial insurance market.
“When we talk about setting aside our differences to solve problems, this is exactly what we mean,” said Rep. Carnahan. “This common-sense bipartisan legislation will get life-saving medicines to those who need them.”
Off-label prescribing is widespread in the medical community as an essential means of providing patients with optimal medical care. Under Medicare Part B, CMS allows carriers to consider “the major drug compendia, authoritative medical literature and/or accepted standards of medical practice” in determining whether an off-label use is medically accepted. In 2008, through the Medicare Improvements for Patients and Providers Act (MIPPA), Congress required CMS to apply the Part B standard to Part D cancer drugs used off-label.
“The Part D Off-Label Prescription Parity Act takes a balanced approach to keeping patients safe from improper prescribing while allowing access to the most up-to-date treatments available, “ said Joe Baker, President of the Medicare Rights Center. “Doctors routinely prescribe medications for uses other than those on the FDA label, according to their professional judgment and evidence in the medical literature. We are grateful Congressmen Thornberry and Carnahan have re-introduced this important bill,” he continued.
The bill is also supported by the National Multiple Sclerosis Society, the Medicare Access for Patients-Rx (MAPRx), as well as:
The AIDS Institute
The ALS Association
The Alzheimer’s Association
American Academy of Neurology
American Autoimmune Related Diseases Association
American Society of Consultant Pharmacists
Center for Medicare Advocacy
Hemophilia Federation of America
The Lupus Foundation of America
Men’s Health Network
Mental Health America
National Alliance on Mental Illness
National Council for Community Behavioral Healthcare
National Grange of the Order of Patrons of Husbandry
National Health Council
National Spinal Cord Injury Association
National Organization for Rare Disorders (NORD)
United Spinal Association