Medicare announces coverage for new COVID-19 treatment that can be provided in doctors' offices

The Centers for Medicare & Medicaid Services (CMS) has set coverage for a new COVID-19 treatment that doctors should be able to eventually provide in outpatient office settings. CMS announced Nov. 10 that Medicare will cover bamlanivimab, a monoclonal antibodies treatment, with no cost-sharing during the current public health emergency (PHE). The therapy received an emergency use authorization (EUA) from the U.S. Food and Drug Administration on Nov. 9.

Per CMS, Medicare patients can receive bamlanivimab infusions in a range of settings, including a doctor’s office, if safety standards are met. Initial allocations of the medication are expected to go to hospitals, however.

CMS anticipates bamlanivimab will initially be given to health care entities at no charge. If that’s the case, Medicare will not pay for the product itself, but will pay for infusion of the product. When the initial no-charge period ends and physicians have to purchase bamlanivimab or other monoclonal antibody products, CMS plans to set the payment rate at 95% of the average wholesale price — the same way it will set the payment rates for COVID-19 vaccines. CMS will issue billing and coding instructions in the coming days.

Monoclonal antibody infusion is also expected to be covered, with limited exceptions, when furnished to Medicaid patients during the pandemic. That’s because, under section 6008 of the Families First Coronavirus Response Act, state and territorial Medicaid programs can only receive a temporary increase in their federal Medicaid matching funds if they cover COVID-19 testing services and treatments for Medicaid patients without cost sharing.

More details on the monoclonal antibody COVID-19 infusion program are available on the CMS website.

— Kent Moore, Senior Strategist for Physician Payment, American Academy of Family Physicians

Posted on Nov 13, 2020 by Kent Moore