MedicaidDocumentationMedium impact
MMP 25-12: Physician Administered Drugs Administered for Off-Label Indications
Michigan Medicaid - MDHHS·MI·Provider Bulletin
Effective date
May 1, 2025
We identified it
Jun 20, 2026
Summary
Michigan Medicaid clarified coverage requirements for physician-administered drugs used for FDA off-label indications. Protected drug classes now require evidence-based documentation to support off-label use, while non-protected drug classes still require prior authorization for off-label uses.
Action Required
By May 1, 2025: Billing team must establish workflow to identify off-label physician-administered drug claims and determine if drugs are in protected classes per MCL 400.109h. For protected drug classes, ensure providers document evidence-based support (medical compendia, peer-reviewed studies, progress notes, or failed treatment documentation). For non-protected classes, continue obtaining prior authorization for off-label uses. Update EMR templates to capture required documentation.