Coverage Information for Monkeypox

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 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.

​​​​​​​Dig deeper: For more information on monkeypox, see the Centers for Disease Control and Prevention¹ or the World Health Organization¹ sites.

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