BCBSAZ Coverage Updates

Our members need us more than ever. Our commitment to supporting their health in the time of COVID-19 is at the heart of several critical coverage updates that help ensure easier and more affordable access to care.

These updates have been implemented for all fully insured members. Self-funded customers have the option of making these updates available to their employees, so the updates below may not apply.

Testing and Treatment

COVID-19
Testing
No cost share COVID-19 testing is a covered benefit with all of our medical plans. What’s new is that members won’t have a copay or co-insurance for COVID-19 diagnostic testing. Testing must be ordered by a physician (MD/DO), nurse practitioner, physician assistant, or authorized pharmacist and performed according to guidelines from the Centers for Disease Control and Prevention (CDC).

COVID-19
Testing & Treatment
No prior authorization required BCBSAZ is waiving prior authorization (precertification) for diagnostic tests and covered treatment services that are medically necessary and consistent with CDC guidance for members who have been diagnosed with COVID-19.

COVID-19
Treatment
No cost share for in-network services

BCBSAZ members will be able to get the vaccine for $0

Every state is handling the distribution and registration for vaccines differently. For current vaccine registration and distribution information in:

Antibody
Testing
No cost share Covered with no cost share or preauthorization when the test is:
  • FDA-approved or have received emergency use approval (EUA) from the FDA;
  • Ordered by a physician (MD/DO), nurse practitioner, physician assistant, or authorized pharmacist; and
  • Conducted at a qualified lab. At-home tests are covered with a provider’s order when processed by a qualified lab.

COVID-19 Testing

No cost share

COVID-19 testing is a covered benefit with all of our medical plans. What’s new is that members won’t have a copay or co-insurance for COVID-19 diagnostic testing. Testing must be ordered by a physician (MD/DO), nurse practitioner, physician assistant, or authorized pharmacist and performed according to guidelines from the Centers for Disease Control and Prevention (CDC).

COVID-19 Testing & Treatment

No prior authorization required

BCBSAZ is waiving prior authorization (precertification) for diagnostic tests and covered treatment services that are medically necessary and consistent with CDC guidance for members who have been diagnosed with COVID-19.

COVID-19 Treatment

No cost share for in-network services

BCBSAZ is waiving all copays, co-insurance, and other cost-sharing related to COVID-19 treatment from in-network providers through May 2020.
This means that members will pay $0 out-of-pocket should they or a family member covered under their BCBSAZ plan need treatment for COVID-19.

Antibody Testing

No cost share

Covered with no cost share or preauthorization when the test is:

  • FDA-approved or have received emergency use approval (EUA) from the FDA;
  • Ordered by a physician (MD/DO), nurse practitioner, physician assistant, or authorized pharmacist; and
  • Conducted at a qualified lab. At-home tests are covered with a provider’s order when processed by a qualified lab.

Monoclonal Antibody Treatment

Throughout the pandemic, we’ve been committed to providing our members access to COVID-19 treatments, vaccines, and more, to help stop the spread of the virus. In that spirit, we are pleased to offer monoclonal antibody treatment to high-risk members who have tested positive for COVID-19 and have mild to moderate symptoms—and at no extra cost. Members can receive monoclonal antibodies treatment for COVID-19 if they meet the eligibility requirements and get a referral from their provider.

Monoclonal antibodies are made in a lab through a safe and effective cloning process using a single white blood cell. The antibodies help strengthen the immune system. The treatment has received emergency use authorization from the Food and Drug Administration because it has been proven to reduce severe COVID-19 illness and prevent hospitalizations and death.

Who is eligible?

The mAb treatment will be offered across Arizona. Members living in remote areas may be invited to travel to an outpatient infusion center for treatment. Eligibility criteria for treatment are:

  • A positive COVID-19 PCR test within the previous ten days
  • Experiencing mild to moderate symptoms
  • Age 5 or older and considered high-risk for serious illness or hospitalization from COVID-19—see the list of high-risk groups by the CDC: People with Certain Medical Conditions.

How much does it cost?

Standard cost shares will be waived for members and groups for this specific treatment and medication—except for self-funded groups if they choose to opt-out.

However, if a referral for pre or post-care is needed, a member’s standard cost share will apply for any telemedicine visit(s). Self-insured groups can choose to opt-out.

How do members get access to this treatment?

Members should reach out to their primary care provider to determine if this treatment is right for them. If the member meets the requirements, their provider can write them a referral.

BlueCare Anywhere for urgent care*

When a member doesn’t have a regular doctor, or if their PCP isn’t available or doesn’t offer telemedicine visits, BlueCare Anywhere℠ is available. Members can talk with a board-certified doctor by live video for urgent medical care, psychiatry, and counseling sessions.

Additional information about BlueCare Anywhere is available on our COVID-19 member page.

Prescription Drug Coverage Updates**

*If you are a self-funded employer who has not elected to include BlueCare Anywhere coverage, this section does not apply. Your BCBSAZ sales representative can assist you with any questions about adding BlueCare Anywhere to your medical plan(s).

**Applies only to Groups with BCBSAZ pharmacy coverage.

BlueCare Anywhere is a service mark of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.