The Oregon Department of Consumer and Business Services Division of Financial Regulation under the direction of Andrew Stolfi has issued a bulletin saying that all health care plans in Oregon must cover monkeypox vaccines. It says, "in accordance with ORS 743A.264(2), all health benefit plans (including grandfathered health benefit plans) in Oregon must provide coverage for approved hMPXV vaccines and their administration in accordance with this bulletin."

According to the bulletin, "The virus hMPXV, more commonly known as the monkeypox virus, is a type of Orthopoxvirus with symptoms that include fever, rash, and swollen lymph nodes. The virus has an estimated1 percent case-fatality rate in endemic countries and the potential of higher rates among immunocompromised people. The virus is transmitted to humans through close contact with an infected person or animal, or with material contaminated with the virus. It is then transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets, and contaminated materials such as bedding. Most infections in the current outbreak appear to be due to skin-to-skin contact.

On July 23, 2022, the International Health Regulations Emergency Committee of the World Health Organization declared that the recent multi-country outbreak of the monkeypox virus constitutes a Public Health Emergency of International Concern. On Aug. 4, 2022, U.S. Health and Human Services Secretary Xavier Becerra determined that a Public Health Emergency exists across the United States due to the outbreak of monkeypox cases across multiple states.

the Oregon Health Authority under the direction of Pat Allen issued a public health director’s declaration On Aug. 5, 2022, pursuant to ORS 743A.264, stating that an outbreak of viral illness caused by hMPXV is occurring in Oregon and that vaccination is necessary to prevent the spread of hMPXV. ORS 743A.264 prohibits health benefit plans from restricting coverage for the cost of necessary treatments, vaccines, immunizing agents, pharmaceutical agents, medical supplies, or other prophylactic measures approved by the U.S. Food and Drug Administration that the public health director deems necessary to prevent the spread of a disease.

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A D V E R T I S E M E N T

Further, according to the bulletin, "a health benefit plan may not restrict coverage for an approved hMPXV vaccine and its administration to innetwork providers. Health benefit plans must provide coverage for an hMPXV vaccine in accordance with this bulletin, regardless of whether an enrollee receives the vaccine from an in-network or out-of-network provider. The division encourages health benefit plans to be proactive in including approved vaccinators in their networks and to update operational systems to accept and process out of network vaccine claims.


--Staff Reports

Post Date: 2022-08-11 09:32:23