The Washington Healthcare Forum website now contains information on carriers’ requirements for coverage and payment for Remdesivir. At WSHA’s request, the Forum recently queried carriers on their policies. Carrier responses received to date are posted here. Generally, the carriers indicate Remdesivir is a covered drug for COVID and is reimbursed as part of the negotiated APRDRG payment for the inpatient stay, rather than as a separate payment. The carriers state there is no separate prior authorization needed for the drug, although the inpatient stay itself must be authorized.
The Washington Health Care Authority recently said the same approach may be taken for Medicaid, although the agency is still considering its policies. HCA, however, did announce that Medicaid inpatient claims for COVID, including Medicaid managed care claims, would receive a 20 percent add-on to the regular APRDRG payment. Medicare has a similar add-on payment for COVID inpatient cases.
The Forum site has information posted in a Frequently Asked Questions format and includes telemedicine policies and billing requirements, COVID-19 testing codes and requirements and links to the COVID-19 webpage for most major carriers. If you have a COVID-19 billing or payment question for which you have not yet found an answer, please send it to Andrew Busz, WSHA Policy Director, Finance at firstname.lastname@example.org.