Coverage for antibody infusion therapy

At Horizon BCBSNJ, we want our members to get the care they need, when they need it. Throughout the COVID-19 public health emergency, we have taken comprehensive steps to make it easier for our members to get critical medical and behavioral health services by waiving costs for patients, and by providing significant financial support for hospitals, doctors and medical practices. This includes providing coverage for emerging therapies, including COVID-19 monoclonal antibody (antibody infusion) treatment with bamlanivimab or REGN-COV2 antibody cocktail of casirivimab and imdevimab when given according to the Emergency Use Authorization (EUA) issued by the FDA.

Cost sharing waived

As with all in-network inpatient and outpatient treatment of COVID-19, Horizon BCBSNJ is waiving cost sharing for antibody infusion treatment at in-network facilities through March 31, 2021

This information applies to all fully insured members, including those covered through Medicaid, Medicare Advantage, Individual and Small Group policies, as well as members covered by the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP). Horizon BCBSNJ will continue to work with other self-insured customers that provide coverage for their employees on their specific plan designs.

Claims submissions and billing

Consistent with Federal Medicare, Horizon BCBSNJ will not pay for the monoclonal antibody products that providers receive for free.

However, Horizon BCBSNJ will reimburse for the administration of antibody infusion treatment when given according to the EUA issued by the FDA.

• For Horizon BCBSNJ commercial and Medicaid members, please submit your claims to Horizon BCBSNJ and Horizon NJ Health, respectively.
• For Medicare Advantage members, including D-SNP, the costs for the administration of antibody infusion treatment (as well as claims for the treatment itself when there is a charge for the treatment) will be covered under Original Medicare throughout 2020 and 2021. Please submit claims for administering antibody infusion treatment to Original Medicare through your Medicare Administrative Contractor (MAC). Claims billed to Horizon BCBSNJ for antibody infusion treatment for Medicare Advantage members will be denied.

For more information, please review the CMS guidelines.