42 CFR §410.29
Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
Medicare part B does not pay for the following:
- (a)Except as provided in § 410.28(a) for outpatient diagnostic services and § 410.63(b) for blood clotting factors, and except for EPO, any drug or biological which is usually self-administered by the patient.
- (b)Any drug product that meets all of the following conditions:
- (1)The drug product was approved by the Food and Drug Administration (FDA) before October 10, 1962.
- (2)The drug product is available only through prescription.
- (3)The drug product is the subject of a notice of opportunity for hearing issued under section 505(e) of the Federal Food, Drug, and Cosmetic Act and published in the Federal Register on a proposed order of FDA to withdraw its approval for the drug product because it has determined that the product is less than effective for all its labeled indications.
- (4)The drug product is presently not subject to a determination by FDA, made under its efficacy review program, that there is a compelling justification of the drug product's medical need. (21 CFR 310.6 contains an explanation of the efficacy review program.)
- (c)Any drug product that is identical, related, or similar, as defined in 21 CFR 310.6, to a drug product that meets the conditions of paragraph (b) of this section.