Pharmacy Question for the Week of December 2, 2019

Pharmacy Compliance Question of the Week


When MACs determine whether a drug is self-administered in regards to Medicare coverage, how is “acute condition” defined?


According to the Medicare Benefit Policy Manuel:

“For the purposes of determining whether a drug is usually self-administered, an acute condition means a condition that begins over a short time period, is likely to be of short duration and/or the expected course of treatment is for a short, finite interval. A course of treatment consisting of scheduled injections lasting less than 2 weeks, regardless of frequency or route of administration, is considered acute. Evidence to support this may include Food and Drug Administration (FDA) approval language, package inserts, drug compendia, and other information.”