CMS is warning insurance providers to watch prescriptions of Neudexta for off-label use. Neudexta is a prescription meant to treat symptoms of pseudobulbar affect (PBA), which can cause uncontrollable laughter or crying. As CNN reports, prescribing for off-label use is not illegal, but creating a false diagnosis in order to secure coverage of the prescription is fraud.
A CNN investigation last fall indicated that the prescription drug was being given to those without PBA to control behavior. BlueCross BlueShield of Arizona stated to the FDA that it felt the pharmaceutical maker of the drug marketed it beyond clinical means. The FDA has received other complaints as well.
CMS issued a memo in March 2018 noting the drug will only be covered for medically-accepted uses.