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Insurers Ready to Cover Covid Drug; What Patients Pay Will Vary

Oct. 23, 2020, 6:34 PM

Health insurers are likely to cover the Covid-19 treatment drug remdesivir, but prices paid by patients will vary based on their coverage.

The drug, the first approved by the Food and Drug Administration to treat the coronavirus, is given to patients in hospitals to help them recover more quickly. Representatives for both UnitedHealthcare and Anthem said Friday that the leading insurers are covering remdesivir and are waiving—at least for the time being—cost-sharing such as copays and deductibles.

Out-of-pocket costs are always a major issue with health insurance, and Gilead Sciences Inc.'s $3,120 price to hospitals has drawn criticism from consumer groups.

Because it’s administered in hospitals, the price charged to patients isn’t as “clear cut” as prices charged for drugs picked up in a pharmacy, Eagan Kemp, health-care policy advocate for consumer organization Public Citizen, said.

The majority of people under 65 receive coverage through their employers, but health plans and employers have discretion over what drugs they cover, Sabrina Corlette, a research professor with Georgetown University’s McCourt School of Public Policy, said.

Insurers usually do their own reviews of drugs to determine if they are safe and effective before deciding whether to cover them or how much of the drug’s price they will cover. “Remdesivir is being provided in a number of hospitals already. I think insurers would have already added this to their books,” Kemp said.

Some states have mandated coverage of Covid-19 treatments without requiring enrollees to pay anything for it, Corlette said. Corlette co-authored a paper on state actions related to Covid-19 coverage by private insurers.

Some health insurers have waived out-of-pocket costs such as copays and deductibles for Covid-19 treatment, and they are required to provide testing free of charge to enrollees under the Coronavirus Aid, Relief, and Economic Security (CARES) Act.

United, Anthem Covering Drug

UnitedHealthcare spokeswoman Trasee Carr said the insurer is waiving all out-of-pocket costs for treatment related to Covid-19. She said the company has covered remdesivir when administered as part of a hospital stay since the FDA granted the drug an emergency use authorization in May to treat the disease.

Anthem covers for remdesivir, which currently is only administered in the hospital setting and covered as a medical benefit, Lori McLaughlin, a spokeswoman for the insurer, said.

Anthem is waiving out-of-pocket costs for the treatment of Covid-19 by in-network providers from April 1 through Dec. 31 for members of its fully insured employer, individual, Medicare managed care, and Medicaid plans, she said.

“Inpatient care typically has a per day or per admission copay or deductible, and this would be unlikely to change whether or not remdesivir is administered during the stay,” Cori Uccello, senior health fellow with the American Academy of Actuaries, said.

Cost-sharing for Covid-19 treatments is determined by each insurer, Uccello said. Some insurers have waived any cost-sharing for Covid-19 patients, although this is not universal, she said.

To contact the reporter on this story: Sara Hansard in Washington at shansard@bloomberglaw.com

To contact the editors responsible for this story: Fawn Johnson at fjohnson@bloombergindustry.com; Brent Bierman at bbierman@bloomberglaw.com

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