CMS makes major benefit change to Part D Prescription Drugs

CMS (Centers for Medicaid/Medicare Services) has implemented a significant change to the Part D prescription drug benefit. As of 5/14/2010 prescription drugs that are being prescribed for "off-label" use will not be considered as a Part D reimbursable drug and the claim will be denied.

This means that even if the drug is listed on the Part D providers list of covered drugs, if it is being prescribed for a diagnosis that is "off-label" it will not be covered by Part D or the funds held in a Medicare Set Aside. However if the allocation proposal to CMS does include the future expense of Off Label application of specific prescriptions, then the Medicare Set Aside could pay the benefit.