Pharmacy Question for the Week of September 16, 2019

Pharmacy Compliance Question of the Week


What are some examples of when medications would not be reasonable and necessary according to accepted standards of medical practice?


According to the Medicare Benefit Policy Manual, the following three criteria define when a medication is considered not reasonable:

  • Medications are given that are not for a particular illness
  • When the injection method is not indicated
  • Medications that exceed the frequency or duration of accepted standards of medical practices.