Infusion coverage :Solaris

[Guest guest]

Good morning,

My pharmacy would like to know if Soliris (Eculizumab) is covered by Medicare for rejection prevention. I’m told that it is a very expensive drug, does anyone have any insight or know where I could verify? Any help would be greatly appreciated.

Thanks & happy Monday!

Caryn Riley

Transplant Financial Coordinator

University of Illinois Hospital & Health Sciences System

840 S Wood St Suite 402

Chicago, Illinois 60612

Tel No.

Fax No.

railey1@...

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[Guest guest]

Hi Caryn,

This question has come up at our facility as well. Use of this drug for organ transplant rejection is considered ‘off label’ use. My understanding is that

Medicare will not cover off label use of medications. I tried to search on the web – CMS - and could not find anything conclusive. I am interested in what our peers have to offer.

Deidra M. Simano

Transplant Operations Analyst

Department of Transplant Surgery

Dartmouth-Hitchcock Lebanon

Phone: (603) 653.3689 / Fax: (603) 676.4287

Transplant Secretary (603) 653.3931

Dartmouth-Hitchcock.org

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]

On Behalf Of Riley, Caryn

Sent: Monday, August 20, 2012 8:14 AM

To: TxFinancialCoordinators

Subject: Infusion coverage :Solaris

Good morning,

My pharmacy would like to know if Soliris (Eculizumab) is covered by Medicare for rejection prevention. I’m told that it is a very expensive drug, does anyone have any insight or know where I could verify? Any help would be

greatly appreciated.

Thanks & happy Monday!

Caryn Riley

Transplant Financial Coordinator

University of Illinois Hospital & Health Sciences System

840 S Wood St Suite 402

Chicago, Illinois 60612

Tel No.

Fax No.

railey1@...

*********************EMAIL DISCLAIMER*********************

This email and any files transmitted with it may be confidential and are

intended solely for the use of the individual or entity to whom they are

addressed. If you are not the intended recipient or the individual

responsible for delivering the e-mail to the intended recipient, any

disclosure, copying, distribution or any action taken or omitted to be

taken in reliance on it, is strictly prohibited. If you have received this

e-mail in error, please delete it and notify the sender or contact Health

Information Management .

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This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for

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[Guest guest]

Medicare and other payers will often cover a medication’s “off-label” use (not explicitly approved by the FDA) if we can provide documentation supporting this use in

one or more authoritative compendia, and none list it as not indicated, unsupported, not recommended, or equivalent terms; or in peer-reviewed medical literature. Reliable evidence must demonstrate that the proposed off-label use to treat the specified

medical condition is safe and effective, and that the beneficial effects of the treatment outweigh its risks. The FDA doesn’t go back to add newly accepted uses to the label, so it is not uncommon.

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ]

On Behalf Of Deidra M. Simano

Sent: Monday, August 20, 2012 10:37 AM

To: TxFinancialCoordinators

Subject: RE: Infusion coverage :Solaris

Hi Caryn,

This question has come up at our facility as well. Use of this drug for organ transplant rejection is considered ‘off label’ use. My understanding is that Medicare will not cover

off label use of medications. I tried to search on the web – CMS - and could not find anything conclusive. I am interested in what our peers have to offer.

Deidra M. Simano

Transplant Operations Analyst

Department of Transplant Surgery

Dartmouth-Hitchcock Lebanon

Phone: (603) 653.3689 / Fax: (603) 676.4287

Transplant Secretary (603) 653.3931

Dartmouth-Hitchcock.org

From:

TxFinancialCoordinators [mailto:TxFinancialCoordinators ]

On Behalf Of Riley, Caryn

Sent: Monday, August 20, 2012 8:14 AM

To: TxFinancialCoordinators

Subject: Infusion coverage :Solaris

Good morning,

My pharmacy would like to know if Soliris (Eculizumab) is covered by Medicare for rejection prevention. I’m told that it is a very expensive drug, does anyone have any insight or know where I could verify? Any help would be

greatly appreciated.

Thanks & happy Monday!

Caryn Riley

Transplant Financial Coordinator

University of Illinois Hospital & Health Sciences System

840 S Wood St Suite 402

Chicago, Illinois 60612

Tel No.

Fax No.

railey1@...

*********************EMAIL DISCLAIMER*********************

This email and any files transmitted with it may be confidential and are

intended solely for the use of the individual or entity to whom they are

addressed. If you are not the intended recipient or the individual

responsible for delivering the e-mail to the intended recipient, any

disclosure, copying, distribution or any action taken or omitted to be

taken in reliance on it, is strictly prohibited. If you have received this

e-mail in error, please delete it and notify the sender or contact Health

Information Management .

IMPORTANT NOTICE REGARDING THIS ELECTRONIC MESSAGE:

This message is intended for the use of the person to whom it is addressed and may contain information that is privileged, confidential, and protected from disclosure under applicable law. If you are not the intended recipient, your use of this message for

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