50 Wishes for
Medicare’s Future

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Wish #45:
Allow peer-reviewed literature to support medically-accepted indications for Part D prescription drugs

Medicare has two standards for determining when a medication is covered. One standard, requiring strong evidence in peer-reviewed literature, is used for prescription drugs covered under Part B and select medications under Part D.  The other standard, used for all other Part D medicines, is very narrow. This second standard allows coverage only when the use is listed in one of three privately published compendia, which are expensive to access. Accompanied by strong oversight and consumer marketing protections, Congress should unify these disparate standards.