It is uncommon to have off label use covered. H

It is uncommon to have off label use covered.

Here is 8/1/19 UHC's policy:

2. Off-label Drug Use, means the use of a drug for the purpose that is different from the use for
which the drug has been approved by the Food and Drug Administration (FDA)including offlabel self-injectable drugs, only when all of the following criteria are met:
a. The drug is approved by the FDA (for label usage);
b. The drug is prescribed by a Network/contracting provider for the treatment of a lifethreatening condition or for a chronic and seriously debilitating condition;
c. The drug is medically necessary to treat the condition;
d. The member has failed, is intolerant of, or has contraindications to standard therapies;
e. The drug has been recognized for treatment of the life-threatening or chronic and
seriously debilitating condition by one of the following: The American Hospital Formulary
Service Drug Information, DRUGDEX System by Micromedex, The United States
Pharmacopoeia Dispensing Information or in two articles from major peer-reviewed
medical journals that present data supporting the proposed Off-Label Drug Use or uses
as generally safe and effective unless there is clear and convincing contradictory
evidence presented in a major peer reviewed medical journal;
f. The drug is covered under the member’s injectable drug benefit described in the
outpatient benefits section of the member’s EOC