Off-Label Use of Drugs Without a Medical Policy

Covers off‑label use of FDA‑approved drugs and associated administration when prescribed for conditions such as cancer (including metastatic/unresectable or genetically defined tumors), chronic, disabling or life‑threatening illnesses, and rare/orphan diseases, with specific provisions for HCSC members in Louisiana and Ohio. Coverage requires the drug be FDA‑approved for at least one indication and the off‑label use be supported by an accepted compendium or substantial peer‑reviewed evidence (typically ≥2 major journal articles or recognized compendia/NCCN/DrugDex), with dose/frequency/duration consistent with authoritative sources, and remains subject to member benefit plan, state regulations, contraindications, non‑formulary exclusions, and any specified minimum initial treatment period.

"Therapies proven effective for the relevant diagnosis or procedure based on peer-reviewed scientific literature or authoritative sources."