Medicare beneficiaries won’t have to pay out of pocket for monoclonal antibody therapies to treat Covid-19 during the public health emergency, the Trump administration said Tuesday.
The Centers for Medicare & Medicaid Services said that coverage of those antibody infusions applies to Eli Lilly & Co.’s bamlanivimab, which the Food and Drug Administration authorized Monday for emergency use against mild-to-moderate Covid-19 in adults. Monoclonal antibodies are laboratory-made proteins that imitate the immune system’s ability to fight off viruses, according to the FDA.
“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 in a statement. “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.”
The CMS said it expects health-care providers will initially be able to get the product at no charge. Medicare won’t pay for antibodies that providers get for free, but it will reimburse them for the infusion of the product, the agency said. It said it expects the announcement will enable home health agencies, nursing homes, and a range of other providers to administer the treatment and bill Medicare for the infusion.
Once providers start having to pay for the treatment, the CMS said it “anticipates setting the payment rate in the same way it set the payment rates for COVID-19 vaccines.”
Reprinted with Permission from - Bloomberg Law by Alexis Kramer