Lidocaine patch 5% is indicated for relief of pain associated with post-herpetic neuralgia and temporary relief of localized pain. Lidocaine patch is requested to treat avascular necrosis of the shoulder. The enrollee had tried and failed narcotics for pain control; they made her delirious and confused. Unfortunately using lidocaine for pain for the enrollee’s condition was an off-label (non-FDA approved) use. The Medicare-approved compendia did not contain any citations to support the use of this drug for this condition. Therefore, this drug was not being prescribed for a medically accepted indication as defined by Medicare law.
An exception based on medical necessity could not be considered because Lidocaine patch as prescribed did
An exception based on medical necessity could not be considered because Lidocaine patch as prescribed did