Victory in Medicare’s Coverage of “Off-Label” Prescription Drugs

"off-label" prescription pills

Do you or someone you know take a prescription drug to help with an “off-label”, or non-FDA approved, condition? This is a legal and common practice where doctors can prescribe medicines for treating less common conditions. Yet, until recently, Medicare denied coverage of these drugs.

On February 11, 2022, however, the U.S. Court of Appeals for the 11th Circuit reversed a lower-court decision and found that Medicare must provide coverage for a beneficiary’s off-label use of a medication in Dobson v. Secretary of Health & Human Services, No. 20-11996, 2022 WL 424813 (11th Cir. Feb. 11, 2022). This is great news!

We are grateful to the great advocacy work of our partners at Center for Medicare Advocacy in this victory.

For more information and details, read their recent article on this victory and the legal case that brought it about.

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.