The federal government’s decision to allow Medicare coverage of monoclonal antibody therapy for COVID-19 treatments could be extremely helpful for nursing homes care for symptomatic, positive residents, according to a top expert.
The Centers for Medicare & Medicaid Services announced late Tuesday that coverage for the treatment will be available to beneficiaries who live across a variety of healthcare settings, including nursing homes, at no cost during the public health emergency.
The Food and Drug Administration on Monday issued an emergency use authorization (EUA) for the investigational monoclonal antibody therapy, bamlanivimab, to treat mild to moderate COVID-19 in adults and pediatric patients who are at high risk for progressing to severe COVID-19 and/or hospitalization.
“Nursing home residents, just by their very nature, are the types of people who will benefit from this. They’re at high-risk for bad outcomes and hospitalization. It seems like a good fit,” Karl Steinberg, M.D., president-elect of AMDA — The Society for Post-Acute and Long-Term Care Medicine.
CMS’ coverage will apply to bamlanivimab. The agency added Medicare will cover and pay for the infusions “the same way it covers and pays for COVID-19 vaccines,” once approved and ready for distribution. However, the program will not pay for products that providers receive for free.
“If providers begin to purchase monoclonal antibody products, Medicare anticipates setting the payment rate for the product, which will be 95 percent of the average wholesale price for many health care providers, consistent with usual vaccine payment methodologies. Additionally, Medicare anticipates establishing codes and rates for the administration of the product,” CMS explained in a memo, which also lays out guidelines on how to code for the treatment.
AMDA has recently expressed skepticism about the efficacy of antibody treatments in nursing homes until further studies and research can be conducted. He added that initial studies haven’t shown the treatment to be dangerous or produce a lot of bad reactions among seniors.
On the plus side, Steinberg noted that the therapy treatment can be done in place for residents. Steinberg said if nursing homes embrace the therapy options then “it’s got the chance to really be helpful.”
“To be able to do this in their own room, that’s a real plus for this. It can logistically be done in the nursing home whereas a lot of other things can’t,” he told McKnight’s Long-Term Care News on Wednesday.
“I think it could really help save some people from going to the hospital. Right now, there’s not a whole lot we can do, so at least it’s something that we can do,” he added.
Steinberg also called on the federal government to include facility medical directors in the decision-making process moving forward.
“I just think throughout so much of this COVID crisis we’ve seen sort of an absence of input from people who actually work in nursing homes, like certified medical directors,” he said.