Outpatient Cost and Coverage for Monoclonal

The following frequently asked questions will prepare providers for common questions about monoclonal
antibody treatment cost and coverage in the outpatient setting. Other options are available for inpatient settings.1

Q: What is the cost of the monoclonal antibody products to the patient?
A: 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,
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.  There are additional non-government procured products where insurance coverage and out-of-pocket costs may vary.


Q: Is infusion administration covered by Medicare?
A: Yes. Medicare is covering costs for infusion administration. Learn more about Medicare coverage of the treatment here: https://www.cms.gov/files/document/covid-infographic-coveragemonoclonal-antibody-products-treat-covid-19.pdf

Q: Is infusion administration covered by Medicaid/Children’s Health Insurance Program (CHIP)?
A: Yes. Medicaid/CHIP is covering costs for infusion administration. Learn more on page 2 here:
https://www.cms.gov/files/document/covid-infographic-coveragemonoclonal-antibody-products-treat-covid-19.pdf

Q: Is infusion administration covered by commercial insurance plans?
A: For patients covered under commercial insurance plans, costs of infusion may vary, but many large insurers are waiving all costs. Patients should check with their health plan to determine whether the patient will bear any administration costs.

Q: What about patients who do not have insurance?
A: If patients do not have insurance, they should ask the treatment facility if there are charges for receiving the infusion.

Additional Resources
Additional CMS guidance on coding, billing, payment allowances, and effective dates for COVID-19 Monoclonal Antibodies and their Administration During the Public Health Emergency: 
https://www.cms.gov/medicare/medicare-part-bdrug-average-sales-price/covid-19-vaccines-andmonoclonal-antibodies

https://www.cms.gov/medicare/covid-19/monoclonalantibody-covid-19-infusion

1. In addition to outpatient treatments, on June 24, 2021, the FDA granted an EUA for a recombinant humanized monoclonal antibody (tocilizumab) for certain hospitalized COVID-19 patients.