In our weekly Trends that Matter series, we provide engaging infographics, articles and recent news from healthcare influencers to highlight general trends affecting the pharmaceutical industry. This week's featured topic is payers' views on off-label drug use.
Once medications are approved by the FDA and on the market, the FDA does not control how physicians prescribe them. According to the FDA, "Healthcare providers generally may prescribe the drug for an unapproved use when they judge that it is medically appropriate for their patient."
However, payers can choose whether or not to cover off-label use. Many factors can impact this decision. Here's one example, given by Camm Epstein, Market Access Strategist and Researcher:
"Payers’ views on off-label use are impacted by how desperately needed the therapy is. Rare diseases without an approved drug to treat it, cancers, and other life-threatening conditions are important examples of payer reluctance to aggressively block off-label use, even though the costs can be very high. Negative PR associated with a denial may be costlier than a very expensive medication in certain situations, even if its effectiveness is questionable."
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