Oral Anticancer Drugs

Medicare covers oral anticancer (and related oral antiemetic) drugs only when they meet Medicare benefit eligibility, statutory coverage criteria (see related Policy Article), and are reasonable and necessary for the individual beneficiary. Claims must be billed by the licensed, dispensing entity (or properly enrolled DMEPOS treating practitioner), must be supported by required documentation including a Standard Written Order or WOPD and proof of delivery, and suppliers must follow strict refill and quantity limits (including a one-month maximum supply and defined refill contact/delivery windows).

"Oral anticancer drugs are covered when they are eligible for a defined Medicare benefit category, are reasonable and necessary for diagnosis or treatment (or to improve functioning of a malformed b..."

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