Premera Blue Cross Blue Shield of Alaska Response to COVID-19

  • Premera Blue Cross Blue Shield of Alaska is here to support members, employers, and healthcare providers during the coronavirus (COVID-19) outbreak.

    Updates as of May 11, 2023

    The federal Public Health Emergency (PHE) ends on May 11, 2023. See PHE section for details.

    Get all the latest COVID-19 updates from the Alaska Department of Health and Social Services and the Centers for Disease Control and Prevention (CDC).

    If you have health plan questions not covered in these resources, call Premera’s customer service team at the number on the back of the member ID card, or your provider network team. Every question will be answered as soon as possible.

    We’ll be updating the following FAQ as additional information is available.

    COVID-19 key dates

    COVID-19 Coverage
    Note: See related section for more information about health plan coverage.    		 End Date
    Cost share waivers for FDA-approved COVID-19 diagnostic testing other virus/respiratory testing tied to a COVID-19 diagnosis (Federal Families First Act and Alaska DOI mandate) May 11, 2023
    Antibody tests covered when done in an inpatient setting, late illness onset, or outpatient inflammatory syndrome in children. 

    May 11, 2023

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

    Is the public health emergency (PHE) for COVID-19 ending? Yes. On January 30, 2023, the Biden administration announced that the PHE for COVID-19 is ending on May 11, 2023. This gives the government and others impacted 90 days to wind down current mandates set under the PHE.
    What is a public health emergency? With the declaration of a public health emergency, the federal government is allowed to access funding to prevent, prepare for, and respond to a disease emergency. It waives certain requirements and allows for new mandates to be established in response to the emergency.
    What does the end of the public health emergency mean? The end of the PHE means that most of the mandates under the current PHE for COVID-19 end on May 11, 2023. This could result in a loss of coverage for some people, or increased costs associated with COVID-19 for others.
    Will I 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.
    What about the cost of vaccines? While vaccinations will continue to be free for most members, the cost to insurers (and self-funded employers) will increase. Under the PHE, only the cost of administering the vaccine was allowed to be billed. This was typically around $25 per shot. With the end of the PHE, the federal government will no longer buy COVID-19 vaccines. The cost of the vaccines will now revert to commercial prices, which could range from $82 to $130 per dose. This cost would be borne by self-funded employer groups and health insurers.
    Will the cost of COVID-19 treatments continue to be at no cost? Those with private insurance have not been charged for monoclonal antibody treatment since they were prepaid by the federal government, though patients may be charged for the office visit or administration of the treatment. But that is not tied to the public health emergency, and the free treatments will be available until the federal supply is exhausted. The government has already run out of some of the treatments so those with private insurance may already be picking up some of the cost. We don’t know what the commercial price will be for monoclonal antibody treatments.
    Can I still get free at-home COVID-19 tests? Under the PHE, people could get up to 8 at-home COVID-19 tests per month. That ends on May 11, 2023, meaning any at-home tests after that time will be at cost for the member.

    COVID-19 vaccines

    Note: We’re updating our vaccine FAQs as information becomes available. Information about vaccines and distribution will continue to evolve.

  • New bivalent bivalent vaccines are available from Moderna and Pfizer. Bivalent boosters target both the original COVID-19 virus but also the newer Omicron related variants.

    To be eligible, you must have received your first full dose before receiving an additional dose. The Pfizer bivalent vaccine is available for those 6 months and older. The Moderna bivalent vaccine is available for those 6 months and older.

    Two other vaccines are available: Novavax for those 12 years and up and Janssen for those 18 and up. These do not 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 about appropriate use of the Janssen vaccine.

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

    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.

    View the CDC's ICD-10-CM coding guidance.

     

    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.

    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.

    Get the most up to date list of billing codes, payment allowances and effective dates.

    Until the current government supply runs out, you should continue to bill only for administrative services. Once the supply runs out, and pricing is set, additional information on pricing and codes will be released.

  • COVID-19 testing and cost-share waivers

  • The new drugs being offered to treat COVID-19 currently covered under our policy as emergency use authorization (EUA) drugs may be accepted per policy 05.01.549: Off-label Use of Drugs and Biologic Agents. (Please note: These drugs are covered under mandate and the public health emergency (PHE) and could change.) 

    While Premera 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. Get more information and find a test-to-treat location.

    The rules implemented on January 10, 2022, requiring coverage of over the counter at home COVID test kits will end on May 11, 2023. Test kits purchased prior to May 11, 2023, online or through a network pharmacy will be covered. Kits purchased after May 11, 2023, will no longer be covered.

    The rules implemented on January 10, 2022, requiring coverage of over the counter at home COVID test kits will end on May 11, 2023. Test kits purchased prior to May 11, 2023, online or through a network pharmacy will be covered. Kits purchased after May 11, 2023, will no longer be covered.

    Premera's Benefit Coverage Guideline is effective for serology tests for dates of service July 1, 2020 and forward. Member cost shares may apply. Premera will reimburse for serology tests that are for the purpose of supporting a COVID-19 diagnosis as part of the treatment or management of a patient's medical condition.

    Serological tests will not be covered when provided as the sole basis of diagnosis for current infection with COVID-19.