High impact
Remdesivir (Veklury) (CPB 0982, reviewed 2026-01-13)
Aetna·Effective Jan 13, 2026
Aetna updated its Remdesivir (Veklury) coverage policy effective January 13, 2026, clarifying that coverage applies ONLY to non-hospitalized, high-risk COVID-19 patients in the outpatient setting with strict criteria including confirmed infection, symptoms within 7 days, high-risk status, hepatic/PT assessment, and a maximum 3-day treatment duration. Hospitalized patients are managed under inpatient benefits. All other indications remain experimental/unproven. Billing teams must ensure claims comply with outpatient-only coverage and document all required criteria.