Pharmacy Question for the Week of December 9, 2019

Pharmacy Compliance Question of the Week


What evidence do MACs use when making the determination when applying the exclusion of drugs that are self-administered by a patient?


According to the Medicare Benefit Policy Manuel:

“A/B MACs (A), (B), and (HHH), and DME MACs are only required to consider the following types of evidence: peer-reviewed medical literature, standards of medical practice, evidence-based practice guidelines, FDA approved label and package inserts. A/B MACs (A), (B), and (HHH), and DME MACs may also consider other evidence submitted by interested individuals or groups subject to their judgment.”