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Monoclonal Antibody Treatment May Help High-Risk Avoid COVID-19 Hospitalization

Tuesday, November 30, 2021

According to the US Department of Health and Human Services (HHS), high-risk COVID-19 patients may avoid hospitalization with monoclonal antibody treatment. Please review the following frequently asked questions to help with the referral process for TRICARE beneficiaries. For more information on this treatment, visit the HHS website at CombatCOVID.hhs.gov

Who is considered “high risk”?
Per the FDA’s Emergency Use Authorization (EUA) for COVID-19 monoclonal antibodies, high-risk includes those individuals age 12 years and older who have a medical condition or other factor that puts them at risk for severe COVID-19 progression and/or hospitalization.

What are EUA indications for COVID monoclonal antibody infusion?
Patients must have a positive COVID-19 test or COVID-19 exposure, be at high-risk for clinical progression, and not had symptoms for more than 10 days.

Is a primary care manager referral required?
A referral is required for TRICARE Prime patients to avoid Point of Service (POS) charges. Providers may submit an urgent request to HNFS. A physician’s order (for example, a prescription) with the EUA indication for treatment is needed for the facility providing the infusion.

Is a prior authorization required for infusion in the home?
Yes. TRICARE policy requires prior authorization for monoclonal antibody infusion therapy administered in the home under the home infusion benefit.

How do we find facilities that provide COVID-19 monoclonal antibody infusions?
Currently, there are two locators – one kept by HHS and another by the National Infusion Center Association (NICA) – for providers and military hospitals and clinics to check for local facilities that are providing COVID-19 monoclonal antibody infusion:  

Upon finding a local facility, providers should first contact the facility to learn its referral procedures and whether it can accept patients. Providers can schedule an appointment for the beneficiary or have the beneficiary contact the center to schedule an appointment and bring the physician order to the appointment.