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Coverage and Other Payment Issues

Medicare's current coverage rules effectively provide beneficiary access to innovative therapies, used in conformity with evolving standards of care. The Medicare statute requires carriers to cover off-label uses of cancer therapies when such uses are supported by citations in certain compendia or by clinical evidence in peer-reviewed literature.

Cancer patients frequently require treatment with the most innovative and cutting-edge therapies. Many advances in cancer care involve the discovery of new uses for drugs already approved by the Food and Drug Administration (FDA) for other indications. These off-label uses are a significant part of common medical practice. They are integral to patient care as well as to the discovery of new treatments. Medicare policies that restrict access to off-label cancer therapies would have a significant adverse impact on treatment of cancer patients.

Recent ACCC Policy Statements

Off-Label Coverage Issues

Erythropoiesis Stimulating Agents (ESAs) Issues

Comment Letters:

Useful Links:

Other Payment Issues

Medicare beneficiaries have been eligible to enroll in the Part D prescription drug benefit beginning since January 2006. Part D, enacted by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, will have a significant impact on the practice of medicine and the Medicare beneficiaries that receive needed medical therapies.

Part D:

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