Donated Remdesivir Ineligible for Separate Reimbursement
Gilead Sciences, Inc., announced it will start charging hospitals for remdesivir in July 2020. We will assess this change in Gilead’s payment position and the impact it may have on the availability and use of this investigational therapy. Further details on any change in our approach to the coverage and reimbursement of remdesivir for the treatment of COVID-19 will be reported here.
Facilities receiving donated remdesivir should not separately bill for the product
We continue to provide coverage for medically necessary care for the treatment of COVID-19. The federal government is currently donating remdesivir to facilities for COVID-19 treatment. Remdesivir has been granted emergency use authorization1 from the U.S. Food and Drug Administration for the treatment of COVID-19. However, it is still considered investigational. If providers submit claims for reimbursement for donated remdesivir, we will deny it as not covered. Other medically necessary treatment associated with hospitalization for COVID-19 will be covered.
Gilead Sciences, Inc., the maker of remdesivir, donated the medication2 for treatment of COVID-19. The federal government is distributing remdesivir to facilities at no charge. The donation is part of a unique federal program to assess the drug’s effectiveness in treating hospitalized COVID-19 patients.
Medical Policy Related to Remdesivir
Our Off-Label Use of Drugs Without a Medical Policy indicates that use of a drug that is experimental, investigational and unproven for an indication is considered off-label and not covered. At this time, remdesivir is considered experimental, investigational and unproven for the treatment of COVID-19 and will not be reimbursable.
1 Coronavirus (COVID-19) Update: FDA Issues Emergency Use Authorization for Potential COVID-19 Treatment
2 HHS announces shipments of donated remdesivir for hospitalized patients with COVID-19, May 19, 2020
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