August 23, 2022
We are closely monitoring activity around monkeypox. The government is currently supplying the vaccine, so there should not be a need to seek reimbursement. However, if the vaccine is received by means other than government supply, and a claim is submitted, our standard vaccine coverage applies.
Vaccine coverage: Under medical benefits, the monkeypox vaccine and administration of the vaccine is covered at no member cost share from an in-network provider. For out-of-network claims, we cover at the out-of-network preventive level, which may result in cost sharing.
If and when pharmacies have access to monkeypox vaccines, we will cover under our member’s pharmacy benefit.
Testing and treatment: Monkeypox is diagnosed by taking a swab of a lesion and sending it to a lab for polymerase chain reaction (PCR) testing. Any tests or treatment for monkeypox are covered under a member’s standard medical benefit. This means there may be member cost share since it is not a preventive service.