Bipartisan bill would expand Medicare coverage for off-label drugs

Reps. Mary Jo Kilroy (D-Ohio) and Mac Thornberry (R-Texas) on Thursday proposed legislation expanding Medicare prescription drug coverage to include more off-label uses. 

The bill would eliminate the current prohibition on Part D plans covering non-cancer off-label drugs when those applications are supported by peer-reviewed medical literature.

“Doctors and patients should be able to decide the best safe and effective medications for their treatments,” Kilroy said in a statement.  ”We must fight for the right to be treated with the best, safest medicine in consultation with our physicians, not a government bureaucrat.”

Medicare’s prescription drug benefit, which initially didn’t allow plans to cover drugs for any off-label uses, was amended in 2008 so that off-label drugs used for cancer treatment would be permitted. But plans still can’t cover off-label drugs used to treat other conditions.

The Kilroy-Thornberry bill would eliminate that prohibition in cases where the off-label application is supported by “authoritative medical literature” — the same standard that Medicare currently applies to Part B drugs. 

Patient groups are cheering the arrival of the bill. Joe Baker, president of the Medicare Rights Center, said the proposal creates “uniformity in the rules across the entire Medicare program, expanding treatment options for at-risk populations.” 

“Since the implementation of Part D, the Medicare Rights Center continues to receive calls from Medicare consumers who are unable to access medically necessary prescriptions, even when the use is supported by the available medical literature,” Baker said in a statement. 

The Kilroy-Thornberry bill, he added, “finally grants all Medicare consumers access to safe and effective prescription treatments, regardless of the condition from which they suffer.” 

The proposal also has the strong backing of the National Multiple Sclerosis Society.