Public Health Emergency - Leading a Nation Prepared
The following frequently asked questions will prepare providers for common questions about COVID-19 monoclonal antibody treatment cost and coverage. The federal government has purchased a supply of certain monoclonal antibody treatments available for use in outpatient settings. There are additional non-government procured monoclonal antibody products available for use in the outpatient setting.
Other non-government procured monoclonal antibody options are available for inpatient settings. On June 24, 2021, the FDA granted an EUA for Actemra (Tocilizumab), a recombinant humanized monoclonal antibody for certain hospitalized COVID-19 patients.
It is important to note that the cost of the product and the cost to administer the product are separate. Because the federal government has purchased a supply of certain monoclonal antibody treatments, in many cases there is no cost to the patient for the monoclonal antibody products themselves; however, there may be costs incurred from administration of the product. Checking insurance coverage is advised. For non-government procured monoclonal antibody products, such as Sotrovimab and Actemra (tocilizumab), insurance coverage and out-of-pocket costs may vary.
Yes. Medicare is covering costs for infusion and injection administration.
Yes. Medicaid/CHIP is covering costs for infusion and injection administration.
For patients covered under commercial insurance plans, costs of infusion and injection may vary, but many large insurers are waiving all costs. Patients should check with their health plan to determine whether they will bear any administration costs.
If patients do not have insurance, they should ask the treatment facility if there are charges for receiving the infusion.
Additional CMS guidance on coding, billing, payment allowances, and effective dates for COVID-19 Monoclonal Antibodies and their Administration During the Public Health Emergency:
Additional resources for uninsured patients are provided by the Health Resources & Services Administration (HRSA) for COVID-19 claims reimbursement to health care providers and facilities for treatment.
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