LifeWise Response to COVID-19

LifeWise Health Plan of Washington is here to support members, employers, and healthcare providers during the coronavirus (COVID-19) outbreak.

Updates as of September 20, 2023

There are new COVID vaccines available. Find out more, including where to get your vaccine, below.

Frequently asked questions about COVID-19 and health plan coverage

Ending the Public Health Emergency (PHE) for COVID-19

The public health emergency (PHE) for COVID-19 ended. On January 30, 2023, the Biden administration announced that the PHE for COVID-19 is ending on May 11, 2023. The end of the PHE means that most of the mandates under the current PHE for COVID-19 ended on May 11, 2023.

Questions

Answers

Will consumers have to pay for COVID-19 vaccines and boosters now?

COVID-19 vaccinations will be at no cost for people with preventive care benefits after May 11, 2023. For those without commercial insurance, the federal government is providing access through specific providers and pharmacies under the CDC’s Bridge Access Program.

What about the cost of vaccines?

While vaccinations will continue to be free for most members, the cost to insurers will increase. The cost of the vaccines will now revert to commercial prices, which could range from $82 to $130 per dose. This cost should be billed to the patient’s health insurer.

Will the cost of COVID-19 treatments continue to be at no cost?

Treatment for COVID continue to be covered and cost shares may apply.

Can I still get free at-home COVID-19 tests?

Free at home tests are no longer covered. However, the federal government will begin providing free tests to consumers on September 25, 2023. Visit Covidtests.gov to order your free kits.

COVID-19 treatment and cost-share waivers

Is COVID-19 testing covered?

All lab tests for COVID will revert to standard plan benefits, which may include cost shares.

Is COVID-19 treatment covered and are there any limitations?
Treatment costs are still covered as a medical expense. Cost shares may apply.

You can check eligibility and benefits on our website.

How is LifeWise covering the drugs used to treat COVID-19?
The new drugs being offered to treat COVID-19 are currently covered under our policy as EUA drugs may be accepted per policy 05.01.549: Off-label Use of Drugs and Biologic Agents.
Note: These drugs are covered under mandate and the public health emergency (PHE) and could change.

While LifeWise may not cover this drug in certain circumstances, it is not restricted at this time when acquired through government distribution systems.

Because these drugs are approved only through EUA, our stance on this drug could change based on the FDA PHE changes, FDA approval status, or additional data as it becomes available.

Test-to-treat antivirals began distribution by HHS on March 7, 2022. Oral antivirals may only be provided when prescribed by a qualified healthcare provider. Only pharmacies with in-store clinics are eligible for distributing these medications. Learn more and find a test-to-treat location.

COVID-19 vaccines

What vaccines are available?
On Tuesday, September 12, the US Centers for Disease Control and Prevention approved two mRNA vaccines, from Pfizer and Moderna, for those 6 months and older. The updated Novavax vaccine is still under review, but the current formulation of the Novavax COVID vaccine is still available.

The recommendations include:

At least one dose of an updated mRNA vaccine against Covid-19 vaccine this year for those ages 5 and up.
For those 6 months through 4 years, who may be getting their vaccines for the first time, two doses of a Moderna vaccine and three doses of a Pfizer Covid-19 vaccine, with at least one of the doses being an updated 2023 shot are recommended.
For people who are moderately or severely immunocompromised should have had at least three doses of Covid-19 vaccine, with at least one of those doses being an updated shot. They also have the option to get an additional updated vaccine later in the year.

Under the terms of the Affordable Care Act, people with commercial health insurance plans through the government or their employer can receive vaccines at no cost.

The original Novavax vaccine is still available for those 12 years and it doesn’t use the same mRNA base as Pfizer and Moderna.

Janssen COVID-19 vaccine is only recommended for certain individuals. Read the information provided by the CDC regarding appropriate use of the Janssen vaccine.

Check current AMA and CDC code guidelines for updated vaccine codes.

CMS recently updated its COVID-19 vaccine pricing website to include codes, descriptors, and pricing information for the recently approved COVID-19 vaccines.

I have a patient with long COVID-19. Are there codes to use for those symptoms?

As a result of the ongoing COVID-19 public health emergency, the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS) has implemented an additional code, U09.9 - post COVID-19 condition, unspecified.

This code became effective October 1, 2021, to identify conditions following acute COVID-19. It's a secondary diagnosis code added after the specific condition related to COVID-19 is known, such as chronic respiratory failure, loss of smell, loss of taste, multisystem inflammatory syndrome, pulmonary embolism, pulmonary fibrosis etc. This code is not used in cases that are still presenting with active COVID-19 but it conditions which are the consequence of COVID-19.

ICD-10-CM coding guidance can be found at https://www.cdc.gov/nchs/icd/icd-10-cm/

Should I recommend my patients get a flu shot?
The CDC, and many medical practitioners, are strongly recommending everyone get a flu shot this year. With the flu almost non-existent last year due to the stay-at-home orders, masking and handwashing, many are expecting this flu season to come back strongly. According to the CDC, it is safe to get both your COVID-19 vaccine and the flu vaccine at the same time.

How will the vaccine be billed?
Vaccines should be billed as you currently bill other vaccines or flu shots, using the updated codes.

Are there specific codes to use when administering the vaccine?
These codes must be used for the approved COVID-19 vaccines and boosters. You should continue to monitor the AMA site for updated coding and ensure your EMR is updated. CMS recently updated its COVID-19 vaccine pricing website to include codes, descriptors, and pricing information for the recently approved COVID-19 vaccines.