Skip to main content

Analysis

CMS Expands Access for COVID-19 Antibody Treatment

By John Commins  
   November 11, 2020

Medicare will not pay for the monoclonal antibody products that providers receive for free but will reimburse providers for the infusion costs.

Starting immediately, Medicare beneficiaries can get coverage of monoclonal antibodies to treat COVID-19 with no cost-sharing during the public health emergency, the Centers for Medicare and Medicaid Services announced Wednesday.

Medicare's expanded coverage of monoclonal antibody infusions includes bamlanivimab, which got an emergency use authorization from the Food and Drug Administration on Tuesday.

"Today, CMS is announcing a historic, first-of-its kind policy that drastically expands access to COVID-19 monoclonal antibodies to beneficiaries without cost sharing," CMS Administrator Seema Verma said.

"Our timely approach means beneficiaries can receive these potentially life-saving therapies in a range of settings – such as in a doctor's office, nursing home, infusion centers, as long as safety precautions can be met. This aggressive action and innovative approach will undoubtedly save lives," she said.

CMS said the monoclonal antibody likely will be given to providers at no charge, at least at first.

Medicare will not pay for the monoclonal antibody products that providers receive for free but will reimburse providers for the infusion costs.

When providers start buying the monoclonal antibodies, CMS said it will likely set 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.

Billing and coding instructions for providers will be issued in the coming days, CMS said.

Verma said today's initiative will allow a range of providers and suppliers to administer the antibody treatment and bill Medicare, including freestanding and hospital-based infusion centers, home health agencies, and nursing homes.

Medicaid

Under section 6008 of the Families First Coronavirus Response Act, state Medicaid programs may receive a temporary 6.2 percentage point increase in the Federal Medical Assistance Percentage through the end of the quarter in which the COVID-19 public health emergency ends.

"A condition for receipt of this enhanced federal match is that a state or territory must cover COVID-19 testing services and treatments, including vaccines and their administration, specialized equipment, and therapies for Medicaid enrollees without cost sharing," CMS said.

"This means that this monoclonal antibody infusion is expected to be covered when furnished to Medicaid beneficiaries, in accordance with the EUA, during this period, with limited exceptions." 

“Our timely approach means beneficiaries can receive these potentially life-saving therapies in a range of settings – such as in a doctor's office, nursing home, infusion centers, as long as safety precautions can be met. This aggressive action and innovative approach will undoubtedly save lives.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

Medicare's expanded coverage of monoclonal antibody infusions includes bamlanivimab, which got an emergency use authorization from the FDA.

When providers start buying the monoclonal antibodies, CMS said it will likely set the payment rate in the same way it set the payment rates for COVID-19 vaccines.

The expanded access is effective immediately. Billing and coding instructions for providers will be issued in the coming days.


Get the latest on healthcare leadership in your inbox.