Medicare will cover monoclonal antibody infusions to treat COVID-19 with no cost-sharing for beneficiaries during the public health emergency, CMS said Tuesday.
The move came a day after the Food and Drug Administration allowed emergency use of Eli Lilly's bamlanivimab, an antibody that helps the immune system fight the virus. CMS expects Eli Lilly will give away bamlanivimab to providers early on. Medicare won't pay for antibody products that providers get for free, but it will pay providers to administer them.
"When healthcare providers begin to purchase monoclonal antibody products, Medicare anticipates setting the payment rate in the same way it set the payment rates for COVID-19 vaccines, such as based on 95% of the average wholesale price for COVID-19 vaccines in many provider settings," CMS said in a statement. The agency promised to give providers billing and coding instructions "in the coming days."
A wide range of providers and suppliers will be able to bill Medicare to deliver antibody therapies, including freestanding infusion centers, home health agencies and nursing homes.
Medicaid plans will probably cover the treatments during the public health emergency too. States could lose extra federal money for their Medicaid programs if they don't cover COVID-19 testing and treatments with no out-of-pocket costs for beneficiaries.
Eli Lilly's antibody therapy is similar to the one President Donald Trump got after he came down with the virus in October. The FDA approved it on an emergency basis to treat people 12 and older with mild or moderate symptoms that don't need to be hospitalized.
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November 12, 2020 at 12:28AM
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Medicare will pay for COVID-19 antibody infusions - Modern Healthcare
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