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Consumer Advisory - Maryland health carriers required to cover the administration of FDA-authorized antibody therapies for COVID-19 with no cost-sharing for patients

Aviso al consumidor: todas las compañías de seguros de salud de Maryland deben cubrir la administración de las terapias con anticuerpos contra la COVID-19 autorizadas por la FDA sin costos compartidos para los pacientes

소비자 자문 - 메릴랜드 건강 보험사는 환자에 비용 분담없이 코로나19 (COVID-19) 대한 식품의약청(FDA) 승인 항체 요법의 투여를 보장해야합니다

BALTIMORE – The Hogan Administration has taken action to assure that Marylanders that fall within the FDA’s emergency use authorization for certain antibody therapies for COVID-19 will have access to those therapies at no charge.

The U.S. government has purchased doses of those therapies and provided them to the states for distribution to health care providers at no charge.  Monoclonal antibodies are provided at no cost to patients. However, there may be other associated costs related to the process of infusing the antibodies.  Maryland Insurance Commissioner Kathleen A. Birrane has invoked her emergency powers to require Maryland health insurers to cover the cost of administering these therapies to their insured members with no cost sharing.

The Bulletin issued by the Commissioner on March 22, 2021:

  1. Prohibits health insurance carriers from denying a claim or authorization request for coverage for the administration of monoclonal antibody therapies, including Bamlanivimab and the combination of Casirivimab and Imdevimab, on the ground that such therapy or treatment modality is experimental or investigational; and
  2. Directs health insurance carriers to waive any cost-sharing, including copayments, coinsurance, and deductibles, for the administration of monoclonal antibody therapies, including Bamlanivimab and the combination of Casirivimab and Imdevimab.

The FDA issued an emergency use authorization for the investigational monoclonal antibody therapy bamlanivimab for the treatment of mild-to-moderate COVID-19 in adult and pediatric patients with positive results of direct SARS-CoV-2 viral testing and who are at high risk for progressing to severe COVID-19 and/or hospitalization. The FDA also issued an emergency use authorization for casirivimab and imdevimab to be administered together for the treatment of mild-to-moderate COVID-19 in the same set of high-risk adult and pediatric patients.

Monoclonal antibody treatment is recommended by the Infectious Diseases Society of America and the National Institutes of Health after a study found the treatment resulted in a 70% risk reduction of hospitalization or death. In Maryland, a total of 5,149 patients have received this treatment, resulting in approximately 242 avoided hospitalizations and 99 avoided deaths.

The Maryland Department of Health (MDH) is urging providers to obtain these therapies for their patients. Administration of these products is a medical decision and requires a physician’s referral. If you have a patient that may benefit from a COVID-19 therapeutic as described, please contact your pharmacy provider and/or home infusion organization for further instruction, as appropriate. Referral pathways are as follows:

  • Option 1: CRISP eREFERRAL (preferred method)
  • Option 2: Maryland Department of Health (MDH) Referral Form The MDH form is specific to mAb infusion and is accessible via the Provider Resources page at: coronavirus.maryland.gov.

MDH provides information for the general public under FAQs about monoclonal antibody treatment on CovidLINK. Resources for professionals are updated weekly on coronavirus.maryland.gov, including this health care provider flyer with information on referrals, treatment locations, and eligibility details. It is important that those at high risk of severe COVID-19 illness, be aware of this accessible treatment option. Eligibility includes everyone over the age of 65 who tests positive and younger groups with other medical conditions. To receive treatment individuals must be within 10 days of first experiencing symptoms.

The Maryland Insurance Commissioner has the power, under a declared State of Emergency, to require a health carrier to waive any cost-sharing, including copayments, coinsurance, and deductibles, for treatment for a specified illness and to make a claims payment for treatment for a specified illness that the health carrier has denied as experimental.  Governor Larry Hogan first declared a State of Emergency on March 5, 2020, in response to the COVID-19 pandemic and that declaration continues to be extended.

Major health insurers in Maryland have not taken the position that these particular therapeutics are excluded from coverage as experimental and are currently covering the administration of these therapeutics without cost sharing.  However, the Commissioner invoked her emergency powers to assure that the ability of insured individuals to access these treatments without incurring the cost of administration in whole or in part not be dependent on their health insurer.

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