Many cancer treatments are off-label, meaning that there is evidence supporting their use but the drug has not been approved by the Food and Drug Administration (FDA) for that specific treatment. Medicare coverage of off-label drugs is governed by a law that requires coverage to be evidence based and on scientific guidelines called compendia. Only one compendia, assembled by the National Comprehensive Cancer Network (NCCN), is publicly available.
The drug bevacizumab (known as Avastin), is commonly used off-label to treat ovarian cancer, although it is not approved by the FDA for ovarian cancer. Recently, many Medicare patients with ovarian cancer have had problems getting coverage for use of Avastin off-label. The NCCN compendia includes using Avastin for ovarian cancer.
The Ovarian Cancer National Alliance believes that denials of coverage for off label use of drugs that are on the compendia violates the law. Numerous Members of Congress have gone on record decrying these denials, and recently, the Ovarian Cancer National Alliance met with representatives of the Center for Medicare and Medicaid Services regarding this issue. We will keep you updated on progress, but if you have trouble with Medicare reimbursement, please contact the Ovarian Cancer National Alliance at firstname.lastname@example.org