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  • Washington Highlights

    Medicare Will Cover Monoclonal Antibody Treatment for COVID-19


    Gayle Lee, Director, Physician Payment & Quality

    The Centers for Medicare & Medicaid Services (CMS) announced that starting Nov. 10, Medicare beneficiaries can receive coverage for monoclonal antibodies to treat COVID-19 with no cost-sharing during the public health emergency.

    The CMS coverage of monoclonal antibody infusions applies to bamlanivimab, which received an emergency use authorization from the U.S. Food and Drug Administration.

    Beneficiaries can receive these therapies in a range of settings — including a doctor's office, nursing homes, freestanding and hospital-based infusion centers, and home health agencies — as long as safety precautions can be met. Initially, the monoclonal antibody will be given to providers at no charge. Medicare will not pay for the monoclonal antibodies that providers receive for free but will reimburse providers for the infusion costs.

    In the future when providers pay for the monoclonal antibodies, a payment will be set by Medicare for the provider to cover the product. The CMS anticipates setting the payment rate the same way it set the payment rates for COVID-19 vaccines, based on 95% of the average wholesale price for COVID-19 vaccines in many provider settings. The CMS will issue billing and coding instructions for health care providers in the coming days.