Maybe, maybe not:
Earlier this week, we pondered how (and/or if) off-label uses of certain meds might be covered. I reached out to one of our carriers (whose rep was willing to at least kick this up the food chain for me). In the meantime, a commenter points out:
"The FDA issued an emergency-use authorization late Sunday for chloroquine and its next-generation version, hydroxychloroquine, as treatments for the novel coronavirus"
So it will be interesting to see how that plays out.
Oh, I have now heard back from my "inside source," who offers this helpful perspective on the general subject:
Earlier this week, we pondered how (and/or if) off-label uses of certain meds might be covered. I reached out to one of our carriers (whose rep was willing to at least kick this up the food chain for me). In the meantime, a commenter points out:
"The FDA issued an emergency-use authorization late Sunday for chloroquine and its next-generation version, hydroxychloroquine, as treatments for the novel coronavirus"
So it will be interesting to see how that plays out.
Oh, I have now heard back from my "inside source," who offers this helpful perspective on the general subject:
"Once a physician writes a prescription and the member has it filled by a pharmacy, the pharmacist won’t know specifically what is the patient’s diagnosis, or whether or not the physician prescribed something for the patient that is prescribed for an off label use.
Many specific drugs have programs such as Prior Approval and Step Therapy associated with them. The latter will require the physician to submit to Anthem for a prior authorization, indicating why a member needs a specific medication - or in the case of Step Therapy, the patient would have to try a medication in that same class, before what is written can be filled. The latter typically halts the use of “off label” prescribing for most of the higher cost brand medications."
Thank you!
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