Michelle Winokur, DrPH 

Starting next year, Medicare will cover monoclonal antibodies as a preventive treatment against COVID-19. (1) By including mAbs under Medicare Part B for the first time, the Centers for Medicare and Medicaid Services will expand patient access to these powerful – and now affordable – drugs. 

Permanent coverage under Medicare Part B’s vaccine benefit means seniors can get mAbs at no out-of-pocket cost. This is a substantial change in the short term, especially with an anticipated winter wave of COVID-19. (2) 

An Important Precedent 

Long-term, covering mAbs as prophylaxis for seniors signals the federal policymakers’ potential openness to covering them for children. This precedent points toward CMS eventually including preventive mAbs, a type of immunization, in the federal government’s Vaccines for Children Program. 

If mAbs are approved for preventive care, at no cost, for one large population vulnerable to respiratory diseases – seniors- they should be available to all such patients, including infants and children. 

RSV and the Case for Inclusion 

Infants, the principal beneficiaries of the Vaccines for Children Program, are at particular risk of the respiratory syncytial virus. Indeed, 97% of all babies contract RSV by age 2, (3) which is the leading cause of bronchiolitis and pneumonia among infants. (4) Next-generation RSV preventive mAbs are already in development and could, for the first time, provide protection to all infants and reduce the burden of RSV on both patients and the healthcare system. 

CMS’s decision to provide seniors coverage for mAbs as a preventive treatment for COVID-19 may pave the way for other preventive mAbs that protect infants and children from RSV. (5)Such a policy would undoubtedly be welcome news for parents and providers hoping to protect infants and young children from the really serious virus. 

References: 

1. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule 
2. https://www.nature.com/articles/d41586-022-03157-x
3. https://healthpolicytoday.org/2022/06/15/respiratory-syncytial-virus-takes-a-toll-on-families/
4. https://www.cdc.gov/rsv/index.html
5. https://healthpolicytoday.org/2022/03/31/alleviating-the-burden-of-rsv-for-infants-and-children/

Michelle Winokur, DrPH, is the Executive Director of the Institute for Patient Access. This article was also published at healthpolicytoday.org.