Q. Where can I find information to support a request for Medicare reimbursement for a drug?

Answer

Medicare changed the list of sources/compendia that can be used for these reimbursement requests in 2009. The following journal article documents the change in Medicare policy.

Tillman K, Burton B, Jacques LB, Phurrough SE. Compendia and anticancertherapy under Medicare. Ann Intern Med. 2009 Mar 3;150(5):348-50. Epub 2009 Feb16. PubMed PMID: 19221368. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19221368


What I gleaned from this article:

The following library-licensed, online drug information resources are considered acceptable information sources:

MICROMEDEX's DrugDex is one of the acceptible compendia.  McGoogan Library no longer licenses this resource.

The USP DI ceased publication in 2007.  But it appears that this resource was still considered an acceptable source of information when the Tillman article was published in 2009.  It is available in print in the Library.

The NCCN Drugs and Biologics Compendium is also considered an acceptable information source.  This compendium is now available only by subscription.  Institutional subscriptions are expensive but the individual subscription rate is not exorbinant.

The AMA DE has been removed from the list of suitable sources for requests for Medicare reimbursement.
 

More information about the compendium approval process is available at: http://www.cms.gov/Medicare/Coverage/CoverageGenInfo/compendia.html  Some of the approved sources are only mentioned in the "Related Links" section of this page.

  • Last Updated Jul 15, 2017
  • Views 92
  • Answered By Cindy Schmidt

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