September 1, 2022
We’re closely monitoring activity around monkeypox. The government is currently supplying the vaccine, so there shouldn’t be a need to seek reimbursement. However, if the vaccine is received by means other than government supply, and a claim is submitted, our standard vaccine coverage applies.
Vaccine coverage: Under medical benefits, the monkeypox vaccine and administration of the vaccine is covered at no member cost-share from an in-network provider. For out-of-network claims, we cover at the out-of-network preventive level, which may result in cost-sharing.
If and when pharmacies have access to monkeypox vaccines, we’ll cover under our member’s pharmacy benefit.
Testing and treatment: Monkeypox is diagnosed by taking a swab of a lesion and sending it to a lab for PCR testing. Any tests or treatment for monkeypox are covered under a member’s standard medical benefit. This means there may be member cost-sharing since it’s not a preventive service.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to other third party sources or organizations are not a representation, warranty or endorsement of such organization. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.