Pemgarda (pemivibart) Receives Emergency Use Authorization (EUA)
On March 22, 2024, the Food and Drug Administration (FDA) issued EUA for Pemgarda for the prevention of COVID-19 for individuals aged 12 and up with moderate to severe immune compromise due to a medical condition or taking immunosuppressive medications or treatments. These individuals are unlikely to mount an adequate immune response to COVID-19 vaccines. Pemgarda is not a substitute for COVID-19 vaccinations.
MaineCare will provide full coverage without cost sharing through September 30, 2024 for Pemgarda and its administration when provided to eligible individuals as required under the American Rescue Plan Act (ARPA) of 2021.
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Pemgarda |
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Code |
Description |
Effective Date |
MaineCare Rate |
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M0224 |
Intravenous infusion, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known SARS-CoV-2 exposure, who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, includes infusion and post administration monitoring. |
03/22/2024 |
$308.21 |
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Q0224 |
Injection, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known SARS-CoV-2 exposure, and who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, and are unlikely to mount an adequate immune response to COVID-19 vaccination, 4500 mg |
03/22/2024 |
$6583.50 |
Providers are asked to hold claims until May 1, 2024, while MaineCare systems are updated.
If you have questions related to the administration of or reimbursement for Pemgarda, please contact your Provider Relations Specialist.
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