The Centers for Medicare and Medicaid Services (CMS) announced that effective November 10, 2020, Medicare beneficiaries can receive coverage of monoclonal antibodies for treatment of COVID-19 with no cost-sharing during the public health emergency. CMS’ coverage of monoclonal antibody infusions applies to bamlanivimab, which received an emergency use authorization from the U.S. Food and Drug Administration on November 9, 2020.
CMS anticipates that this monoclonal antibody product will initially be given to health care providers at no charge. Medicare will not pay for the monoclonal antibody products that providers receive free, but will provide reimbursement for the infusion of the product when providers begin to purchase monoclonal antibody products. Medicare anticipates setting 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.
CMS further expects Medicaid programs to cover monoclonal antibody infusions during the public health emergency in accordance with Section 6008 of the Families First Coronavirus Response Act.