Does BCBS Cover Paxlovid and Other Covid-19 Treatments

Blue Cross Blue Shield (BCBS) does cover Paxlovid, but with some conditions. BCBS considers Paxlovid a covered medication under their standard health plans.

According to BCBS, Paxlovid is a prescription medication that can be used to treat COVID-19 in certain individuals. BCBS members may be eligible for coverage for Paxlovid if they meet specific criteria.

BCBS members can contact their health insurance provider to confirm coverage for Paxlovid and to discuss any out-of-pocket costs.

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BCBS covers Paxlovid, an antiviral medication, for patients with COVID-19.

Patients must meet certain eligibility requirements, such as being at high risk of severe illness or hospitalization due to COVID-19.

BCBS coverage for Paxlovid may include copays, coinsurance, or other out-of-pocket costs.

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To be eligible for BCBS coverage for Paxlovid, you must be a BCBS member with prescription coverage.

You must have a prescription from a healthcare provider for Paxlovid.

Your healthcare provider must have a valid prescribing relationship with BCBS.

You must meet the medical necessity criteria for Paxlovid as outlined by BCBS.

BCBS members with certain chronic conditions may be eligible for coverage for Paxlovid.

You must be experiencing symptoms of COVID-19 to be eligible for Paxlovid coverage.

For more insights, see: Bcbs for Providers

The cost of BCBS coverage for Paxlovid can be a significant concern for many individuals. The out-of-pocket cost for a 5-day course of Paxlovid is $520, but with BCBS coverage, the cost can be reduced to $0.

BCBS coverage includes a $0 copay for Paxlovid, but the deductible still applies. The deductible for BCBS coverage can range from $500 to $6,000 per year, depending on the specific plan.

Receiving a diagnosis of COVID-19 is required to get the $0 copay for Paxlovid. This is because the medication is only covered for the treatment of COVID-19, not for prevention.

Some BCBS plans may have a coinsurance of 30% for prescription medications, including Paxlovid. This means that you would pay 30% of the medication's cost, and BCBS would cover the remaining 70%.

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To get Paxlovid, you'll need a prescription from a healthcare provider.

BCBS requires a prior authorization for Paxlovid, which can be initiated by the healthcare provider or the patient.

Healthcare providers must submit a prior authorization request to BCBS, which includes the patient's medical history, diagnosis, and treatment plan.

The patient's medical history and diagnosis must meet specific criteria to qualify for Paxlovid coverage.

BCBS will review the prior authorization request and make a decision within 24 to 48 hours.

If the prior authorization is approved, the healthcare provider will receive a notification and can proceed with prescribing Paxlovid.

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BCBS covers Paxlovid, an oral antiviral for COVID-19, at no member cost.

Monoclonal antibody treatments for COVID-19 are also covered by BCBS at no member cost, but only through the end of the calendar year in which the FDA's emergency use authorization for the product ends.

BCBS is continuing to cover monoclonal antibody treatments that are authorized by the FDA for emergency use.

Monoclonal antibody products used for COVID-19 treatment will be covered at no member cost year through the end of the calendar year in which the FDA’s emergency use authorization for the product ends.

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