Question:

What evidence do MACs use when making the determination when applying the exclusion of drugs that are self-administered by a patient?

Answer:

According to the Medicare Benefit Policy Manuel:

“A/B MACs (A), (B), and (HHH), and DME MACs are only required to consider the following types of evidence: peer-reviewed medical literature, standards of medical practice, evidence-based practice guidelines, FDA approved label and package inserts. A/B MACs (A), (B), and (HHH), and DME MACs may also consider other evidence submitted by interested individuals or groups subject to their judgment.”

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