CMS increases Medicare payment for COVID-19 monoclonal antibody infusions
Effective Thursday, the national average payment rate increased from $310 to $450 for most healthcare settings.
(Photo: seksan MonKhonKhamsao/Getty Images)
The Centers for Medicare and Medicaid Services has increased the Medicare payment rate for administering monoclonal antibodies to treat beneficiaries with COVID-19, continuing coverage under the Medicare Part B COVID-19 vaccine benefit. Beneficiaries pay nothing out of pocket, regardless of where the service is furnished, whether that be at a physician's office, healthcare facility or at home.
CMS said the move was part of the ongoing response to the pandemic, which is ongoing after more than a year.
WHAT'S THE IMPACT?
Effective Thursday, May 6, the national average payment rate increased from $310 to $450 for most healthcare settings. CMS will also establish a higher national payment rate of $750 when monoclonal antibodies are administered in a beneficiary's home, including their permanent residence or temporary lodging such as hotels/motels, cruise ships, hostels or homeless shelters.
The new national payment rate for at-home administration of monoclonal antibodies accounts for increased costs associated with the one-on-one nature of the care model, the agency said. CMS based the higher rates on information it received regarding the costs of providing such services in a safe and timely manner. Those costs include clinical staff and personal protective equipment.
CMS said Medicare payments to providers and suppliers will be more aligned to their costs to administer these products.
The new policy is based in part on input from stakeholders, including the home health and ambulatory infusion industries, which provided CMS with information on the costs associated with administering monoclonal antibodies.
THE LARGER TREND
As early as mid-January, during the waning days of the Trump Administration, the Department of Health and Human Services touted the benefits of monoclonal antibody treatments, saying it had been proven effective in those who had already become infected with the virus.
Then in February, the Biden Administration secured a supply of monoclonal antibody treatments – one that uses two antibodies, bamlanivimab and etesevimab, to treat nonhospitalized high-risk COVID-19 patients.
The U.S. Food and Drug Administration issued emergency use authorization for Eli Lilly's therapeutic of bamlanivimab and etesevimab on February 9. The treatment is administered through an intravenous infusion and is intended for nonhospitalized patients with confirmed COVID-19 who are experiencing mild to moderate symptoms and are at high risk for severe symptoms and hospitalization. The treatment uses a single dose for each patient.
Eli Lilly developed the bamlanivimab and etesevimab treatment without federal support. The two monoclonal antibodies that make up the combination therapeutic were identified from blood samples taken from patients who recovered from COVID-19.
In March, HHS said it planned to invest $150 million to increase access to monoclonal antibody therapeutic treatments for patients in vulnerable communities. The money may be used to increase staffing, set up infusion centers and purchase necessary equipment, HHS said.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
