The Michigan Department of Health and Human Services (MDHHS) released Bulletin MMP 25-12 on April 1, 2025, which clarifies the use of physician-administered drugs given for off-label indications. 

Effective May 1, 2025, the following policy will be implemented: 

Coverage of off-label use of protected drug classes 

Claims submitted for the U.S. Food and Drug Administration off-label use of physician-administered drugs within the protected drug classes must include documentation to support that the indication is evidence-based and confirms that it is being administered within generally accepted standards of practice. Acceptable documentation may include, but is not limited to, documents from medical compendia, peer-reviewed studies, progress notes, or provider letters that demonstrate other failed lines of treatment. 

Coverage of off-label use of non-protected drug classes 

Prior authorization continues to be required for claims for off-label uses of drugs not included in the protected drug classes. Refer to the Michigan Department of Health and Human Services Medicaid Provider Manual for additional information.

Click here to read the full announcement.