OBJECTIVES: The objective of this study is to determine how 25 major private US payers use approved compendia and treatment guidelines when creating oncology coverage policy for product usage outside of Food and Drug Administration (FDA) approved indications.  METHODS: Primary and secondary research was conducted on the oncology coverage policies of US payers, n=25, to determine if they follow the Centers for Medicare & Medicaid Services (CMS) recommended guidelines on use of compendia when making coverage policy decisions.  Payer polices reviewed include:  United, Anthem, PacifiCare, Empire BC/BS, CIGNA, BC/BS of AB, Oxford, BC/BS of TN, Kaiser, Humana, BC/BS of  IL, CareSource, BC/BS of NC, CareFirst, Wellpoint, BC/BS of MN, Highmark, Aetna, Golden Rule, BC/BS of MI, Independence, BC/BS of FL, BC/BS of MA,  BC/BS of WA,  BC/BS of TX. RESULTS: Of the 25 US payers surveyed, 12 payers follow CMS published guidelines that now mandate that coverage can be given if an indication has a positive review in one of the approved compendia and as long as no one compendia has a negative listing of the indication.  A total of 8 payers have authored unique coverage policies that often are broader than CMS’ guidelines.  Such policies often include coverage for indications listed in the National Comprehensive Cancer Center (NCCN) Drug & Biologics Compendia as class IIb or III.  The remaining five payers continue to rely on CMS’ previous policy prior to the expansion of the compendia list.  CONCLUSIONS: The majority of the 25 US private payers surveyed have oncology coverage policies for non FDA indicated uses that either mirror CMS’ compendia policy, or are somewhat more liberal in their interpretation based on their review of published data and reliance on lower levels of evidence.