Medicare will cowl monoclonal antibody infusions to deal with COVID-19 with no cost-sharing for beneficiaries through the public well being emergency, CMS mentioned Tuesday.
The transfer got here a day after the Meals and Drug Administration allowed emergency use of Eli Lilly’s bamlanivimab, an antibody that helps the immune system combat the virus. CMS expects Eli Lilly will give away bamlanivimab to suppliers early on. Medicare will not pay for antibody merchandise that suppliers get without cost, however it’ll pay suppliers to manage them.
“When healthcare suppliers start to buy monoclonal antibody merchandise, Medicare anticipates setting the cost charge in the identical means it set the cost charges for COVID-19 vaccines, equivalent to based mostly on 95% of the typical wholesale value for COVID-19 vaccines in lots of supplier settings,” CMS mentioned in an announcement. The company promised to provide suppliers billing and coding directions “within the coming days.”
A variety of suppliers and suppliers will be capable of invoice Medicare to ship antibody therapies, together with freestanding infusion facilities, house well being businesses and nursing houses.
Medicaid plans will in all probability cowl the remedies through the public well being emergency too. States might lose additional federal cash for his or her Medicaid applications if they do not cowl COVID-19 testing and coverings with no out-of-pocket prices for beneficiaries.
Eli Lilly’s antibody remedy is much like the one President Donald Trump obtained after he got here down with the virus in October. The FDA accepted it on an emergency foundation to deal with folks 12 and older with delicate or average signs that do not have to be hospitalized.