Update: Remdesivir Donated to the Federal Program is Ineligible for Separate Reimbursement
Posted June 16, 2020 (Updated July 2, 2020)
Update: 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.
Blue Cross and Blue Shield of Illinois (BCBSIL) continues 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. Facilities receiving donated remdesivir should not separately bill for the product. Remdesivir is also considered investigational for the treatment of COVID-19. If providers attempt to seek reimbursement for donated remdesivir, BCBSIL will deny the item as not covered. Other medically necessary treatment associated with hospitalization for COVID-19 will be covered.
How is remedsivir donated to facilities?
Gilead Sciences, Inc., the maker of remdesivir, donated the medication 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.
Is remdesivir FDA approved?
Remdesivir has been granted emergency use authorization from the U.S. Food and Drug Administration (FDA) for the treatment of COVID-19. However, it is still considered investigational.
Is remdesivir eligible for coverage?
BCBSIL’s 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. BCBSIL will not cover remdesivir.