Off-label usage of Actiq
Here's a shocker - quoted from a FierceHealthcare piece last November.
"oncologists accounted for only 1 percent of the 187,076 Actiq prescriptions filled at retail pharmacies in the U.S. during the first six months of 2006, The Wall Street Journal reported."
Actiq is only FDA approved for breakthrough cancer pain.
My firm's research indicates that Actiq is among the top three drugs in dollar volume dispensed to workers comp patients. The incidence of cancer in WC is so low as to be unmeasurable.
Comments
What are the rules for coverage of drugs used in obviously unapproved ways? Can insurers legally deny these claims?
Or, if it's legal, is it considered an invitation to provider and member backlash?
Just wondering why the use of drugs in unapproved ways is not being controlled.
Posted by: jd | August 25, 2007 12:12 AM
JD, Its easier to just say yes than to pay for rehab when you say no. And lest you think rehab is not an issue, by the time someone is taking Actiq, they are addicted to drugs, and therefore, must go thru detox.
Susan
Posted by: Susan | September 10, 2007 10:49 PM
I HAVE BEEN PRESCRIBED THIS MED FOR 4.5 YEARS. TAKING 1600. MG 150 DOSES PER MONTH. DID NOT REALIZE HOW BAD ADDICTION WAS UNTIL INS, DENIED PRESCIPTION AND ONLY PAID FOR 120. I COULD NOT AFFORD REMAINING 30 DOSES AT 1600.00 PER BOX 30.
Posted by: RANDY | October 30, 2007 9:45 AM