Coverage 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.

Medicare coverage policies and off-label issues continue to be a primary area of focus for ACCC. ACCC has emerged as a leader in this area, and is committed to ensuring that our members' views are considered as policies are developed.

Erythropoiesis Stimulating Agents (ESAs) Issues:

Comment Letters:

Useful Links:

Matt Farber, Manager, Provider Economics & Public Policy,
Phone 301.984.9496, ext. 221, Email mfarber@accc-cancer.org