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COVID-19: Coverage guidelines for pharmaceutical treatments
August 19, 2020

This article is for all providers caring for our members

Updated August 31, 2020 to add convalescent plasma as having received EUA approval for use in COVID-19 treatment.

Blue Cross Blue Shield of Massachusetts follows federal and state mandated requirements for SARS CoV-2 (COVID-19) treatment coverage. This article clarifies:

  • When drugs for the treatment of COVID-19 are covered
  • When services associated with pharmaceutical treatments do not require a cost share

Commercial members: Managed care (HMO and POS), PPO, and Indemnity

FDA/EUA approved pharmaceutical treatments for COVID-19 infection
Blue Cross Blue Shield of Massachusetts covers all FDA-approved drugs for COVID-19 with no cost share to the member throughout the duration of the public health emergency.

To date, there are no FDA-approved drugs for COVID-19. However, Remdesivir has received emergency utilization approval (EUA) for patients in an inpatient hospital setting who require treatment beyond respiratory support; and convalescent plasma has received emergency utilization approval (EUA) for hospitalized patients.

Drugs under investigation for COVID-19 infection

Drugs that are covered
Several drugs are under investigation through clinical trials as potential treatments for COVID-19 that have shown early benefit. Blue Cross Blue Shield of Massachusetts covers the following drugs when used outside a clinical trial for patients who are in an inpatient hospital setting and require treatment beyond respiratory support, at the discretion of their treating provider:

Please note that standard inpatient payment policy rules apply.

Drugs that are not covered
Blue Cross Blue Shield of Massachusetts does not cover drugs under investigation through clinical trials that have not demonstrated improvement in patient outcomes in early studies or are not recommended for use outside of the clinical trial setting by CDC, NIH, or DPH guidelines.

The following drugs are not covered outside of the clinical trial setting:

  • Blood-derived products (such as SARS-CoV-2 immunoglobulins, Mesenchymal stem cells)
  • Antiviral therapies or immunomodulators without published supporting evidence (such as lopinavir/ritonavir, other HIV protease inhibitors)
  • Other therapies currently under investigation without published supporting evidence

Medicare HMO BlueSM and Medicare PPO BlueSM members

Viral testing
Coverage for Medicare Advantage patients in an inpatient hospital setting who require treatment beyond respiratory support is covered under Medicare Part A and follows CMS guidelines. For more information, see this CMS press release on New Hospital Procedure Codes for Therapeutics in Response to the COVID-19 Public Health Emergency

Resources:

MPC_030620-1N-109