Medicare details

[rrelyea]

Medicare coverage: Not sure whether we should specify should be covered under Part B or not or if we have cost details nailed down yet, perhaps steering committee can weigh in. It’s my understanding some may be responsible for some co pay/ coinsurance cost but need to verify

[rrelyea]

reply from JK: We have been told that Medicare will fully cover the costs of Pemgarda and its administration, as it is treated in the same manner as a vaccine. The information below is from the CMS website. There’s No Cost for Your Patients There’s no cost sharing for people with Medicare for COVID-19 monoclonal antibody products or their administration. This means your patients don't pay a copay/coinsurance or deductible: • Through the end of the calendar year in which the EUA declaration ends, for monoclonal antibody products used for post-exposure prophylaxis or treatment of COVID-19 • Permanently for covered monoclonal antibody products used as pre-exposure prophylaxis for prevention of COVID-19 https://www.cms.gov/monoclonal

[rrelyea]

reply from SW: I’m not sure about “administration“. If there are administrative fees at a facility, those might have to be paid. I would still ask about that, even if on Medicare.

[rrelyea]

JK: So do you think the CMS statement is incorrect?

SW: I guess my concern is if a facility charges an administrative fee for using the facility as opposed to a fee for the product or a fee for infusing or injecting the product.

For example, it could be a fee for using the facility, which might be separate a apart. It’s just not clear to me, and I believe we may have had people who have been on Medicare, who were charged fees in the past like that. Somehow it sounds familiar, but I can’t say for sure.

RB: We've definitely seen facilities fees separate from the cost of the drug in the past. Searching the FB group quickly, I see some info from L about the administration or facility fee for Medicare.

"Actually a fee can be charged for administration of Evusheld. The CMS (Medicare, Medicaid, CHIP) rates are M0220, injection in a facility, $150.50. M0221, injection at home, $250. Other providers can set their rates, in accordance with reg authorities, and differs probably by state. Many providers do not pass this on to customers but do collect it from the gov't. I think any provider asking for outlandish fees should be reported to the state health authority."

SW: Thanks, Rosa.

DB: Thanks, Rosa.

Maybe we link to CMS site with a disclaimer of some sort.

We should get a better idea what’s going to happen once people can actually start getting it but I fear there might be costs involved for some, as we saw with Evusheld.

[rrelyea]

RB: Good idea. The link Laura was referencing then was broken, so we'd need to find current info.

old link: https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies?fbclid=IwZXh0bgNhZW0CMTAAAR2Lq8nCpKVFFWg-17ddvOr7KOmpTHpjndsl5yYkrT7gyc891KkD16-fw0E_aem_ASuHYxg_EkQwZ4V9hbdv9hjfXg0fxXCtpwDL_EFTUAMUXgiTYzmO_QLcG3LlAD1ifUgSr4TLwFQUNThc_kTACnye

RR: I found a “COVID-19 Vaccines & Monoclonal Antibodies” section on: https://www.cms.gov/medicare/payment/part-b-drugs/vaccine-pricing