61 Background: An off-label policy was developed at Massachusetts General Hospital for drugs used in oncology to 1) ensure high quality standards across the cancer center, 2) promote safe and effective care and 3) demonstrate fiscal responsibility and accountability for drug costs. The purpose of this study is to evaluate adherence to the off-label policy around use of chemotherapy/biologics in outpatient oncology. The impact on pharmacy resources will also be evaluated. A secondary objective is to assess reimbursement of high cost drugs. Methods: A retrospective analysis was performed on all off-label requests submitted from May 1, 2012 through January, 2013 to evaluate adherence to policy. The following criteria were assessed: 1) submission at least 3 days in advance of scheduled treatment, 2) reference provided, 3) approval by clinical director and pharmacy, 4) order written as “Exception order,” and 5) reimbursement of high cost drugs without NCCN support (category 1 or 2A). Drugs evaluated for reimbursement included: bevacizumab, cetuximab, albumin-bound paclitaxel, rituximab, trastuzumab, liposomal doxorubicin, ipilimumab, brentuximab, bendamustine, and bortezomib. Data were also collected from electronic order entry reports, eMARs and hospital billing systems. Results: A total of 83 off-label requests were submitted and reviewed over study period. The majority of requests were written as “Exception orders” representing 2.1% of overall cycle 1 orders. Ninety-eight percent of requests were approved; 40% of requests fully met off-label policy criteria; 28% of requests were submitted without 3-day advance notification; of these, 57% were requested on day of scheduled treatment; 30% of requests were submitted without a reference. Thirty-three claims were evaluated for reimbursement; 91% were paid. Bevacizumab (n=22) was the most commonly requested high cost drug. Conclusions: Providers are generally adhering to the off-label policy. Opportunity exists to improve full adherence. This will ensure adequate time for pharmacy and finance review and avoid unnecessary delays in patient care. The majority of claims for high cost drugs were paid.