Coverage for antibody infusion therapy
At Horizon, we want our members to get the care they need, when they need it. Throughout the COVID-19 public health emergency, we have taken comprehensive steps to make it easier for our members to get critical medical and behavioral health services by waiving their out-of-pocket costs , and by providing significant financial support for hospitals, doctors and medical practices. This includes providing coverage for the FDA-approved and authorized monoclonal antibody treatments currently recommended for use by the CDC.
Claims submissions and billing
Consistent with Federal Medicare, Horizon will not pay for the monoclonal antibody products that providers receive free; however, we will reimburse for the administration of these antibody infusion treatments.
When the federal government stops paying for monoclonal antibody products and these products become available through standard pharmaceutical distribution channels, Horizon will reimburse network providers for monoclonal antibodies approved and/or authorized by the FDA and prescribed consistent with current CDC guidelines according to the terms of their participating provider agreement and/or members' plans.
For more information, please review the CMS guidelines.