I’m in the US. This is not true.

Insurance will have prior authorization rules for certain drugs that are expensive that require the doctor to submit documentation of the condition, but in most cases the common medication is simply covered if prescribed. The insurance company does not receive documentation of every condition for every prescription to determine if the prescription is on label or off label.

Insurance companies can and do also support some off label treatments that are commonly used under their prior auth requirements.

I don’t know why there are so many comments in this thread making confident assertions that off label prescribing or insurance or so uncommon. This happens all day long at doctors offices and pharmacies.

This is not true

> insurance typically won't cover off label use

Generally not true but it can be the case, especially for expensive medications

That's a lie, I get off-label drugs prescribed monthly covered.