Expanded Use of Monoclonal Antibody Therapy for High-Risk COVID-19 Patients
A Letter from Dr. Joneigh Khaldun
Thank you for your efforts throughout the COVID-19 pandemic. Whether it is taking care of patients with COVID-19, taking care of patients with other medical needs, vaccinating, or testing, your efforts are very appreciated. The purpose of this letter is to make sure you are aware of another important tool we have to fight this virus, monoclonal antibodies.
The State of Michigan encourages all Michigan’s clinicians who are caring for COVID-19 patients to consider monoclonal antibody therapy (mAb) as recommended by the NIH Treatment Panel, the Infectious Disease Society of America, and other professional organizations. Monoclonal antibody therapy first became available in mid-November following Emergency Use Authorizations (EUA) issued by the Food and Drug Administration (FDA).
While evidence supporting the efficacy of mAb therapy was initially limited, more recent evidence with over 9,000 reported uses in Michigan suggests that mAb therapy is safe, effective, and can significantly reduce hospitalizations and deaths. The Michigan Department of Health and Human Services (MDHHS) is therefore asking each healthcare provider caring for COVID-19 patients to, when deemed clinically appropriate, seek out and prescribe mAb therapy to high-risk patients within 10 days of testing positive based on the current criteria published by the FDA in the EUA.
While Michigan has seen a large number of Michigan hospitals and other health care providers actively and effectively use mAb therapy for qualifying patients, MDHHS believes this therapy is considerably underutilized. Clinicians have indicated that up to 30% of patients who test positive for COVID-19 may qualify for mAb therapy. Given the current surge and considering the potential of mAb therapy to reduce hospital admissions and deaths, MDHHS believes it is important that healthcare providers significantly expand their use of mAb therapy with the goal of at least 50% of eligible qualifying patients (~10% of patients who test positive) receive this therapy within 10 days of developing symptoms. Each individual who tests positive should be screened by their healthcare provider to determine eligibility for mAb therapy.
Expanding Access to mAb Therapy
MDHHS is actively engaging community-based health care providers to expand access to mAb therapy. Any health care facility able to meet the requirements in the bamlanivimab + etesivimab provider fact sheet and the casirivimab + imdevimab provider fact sheet will be eligible to receive the medication free of charge from the federal government. There is no shortage in supply of these drugs, and the federal government has enough on hand to meet the needs of interested treatment facilities. Medicaid, Medicare and most third party insurers cover an infusion administration fee. More information on insurance coverage of antibody treatments can be found at Centers for Medicare and Medicaid Services COVID19 Vaccines and Monoclonal Antibodies.
Availability of mAb therapies, as well as referrals for treatment, may vary from site to site. A viewable map of therapeutics distribution throughout Michigan is available at the MDHHS COVID-19 Therapeutics Information Page, with expansion anticipated in the coming weeks:
Resources
MDHHS is mindful that ultimately these treatments must be based upon the good clinical judgement of the treating clinicians, informed by the evolving evidence. MDHHS remains committed to continuing to fully support healthcare providers. Again, thank you for your continued service throughout this pandemic. Questions can be directed to the MDHHS Community Health Emergency Coordination Center (CHECC) at checcdeptcoor@michigan.gov.
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