Medicare To Use Evidence Development For Off-Label Drug Use? CMS Guidance Unclear

CMS’ guidance on its “coverage with evidence development” policy for Medicare Part B does not elaborate on the scope of its application to off label drug use, only stating the agency could apply CED to drugs that have received FDA approval for at least one indication.

Manufacturers may want to seek CMS' advice on how Medicare's "coverage with evidence development" applies to drugs, despite – or perhaps as a result of – a new final CED guidance.

Under CED, manufacturers agree to conduct clinical studies as a condition for obtaining coverage of their product. It can be part of a National Coverage Determination, under which a CMS...

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