Physician COVID-19 Treatment Information

Banner Health is offering monoclonal antibody infusions in our outpatient infusion centers for patients who are eligible for treatment. View our outpatient infusion referral orders and contact information. These antibody treatments have not been approved, but have been authorized for emergency use by the FDA, to treat mild to moderate COVID-19 in adults and pediatric patients (12 years of age or older, weighing at least 40 kg) with positive results of SARS-CoV-2 viral testing, and who are at high risk for progressing to severe COVID-19 and/or hospitalization. This authorization is only for the duration of the declaration that circumstances exist justifying the authorization of the emergency use of these antibodies under Section 564(b)(1) of the Act, 21 U.S.C. § 360bbb-3(b)(1), unless the authorization is terminated or revoked sooner.

You can refer a patient by following these steps, which does include completing the outpatient infusion referral order and faxing to an outpatient infusion center currently offering this treatment, along with these documents, which must be completed and signed by a physician, physician assistant or nurse practitioner.  

1. Clinical note
2. COVID lab result 
3. Patient demographic information 

Patient Referral Process for Monoclonal Antibody Treatment

Information regarding the FDA’s Emergency Use Authorization for casirivimab/imdevimab can be found on the FDA’s website.

To refer an eligible patient for monoclonal antibody treatment, you must have:

• Patient has documentation of a positive PCR or direct antigen COVID test.
• Confirm that your patient is at least 12 years old and have mild to moderate COVID-19 symptoms that began less than 10 days ago.
• Confirm that your patient is at high risk for developing severe symptoms or requiring hospitalization.
• Evaluate and identify what high-risk criteria is present with the patient, options include:
  • Age 65 or greater
  • Pregnant
  • Chronic kidney disease
  • Diabetes
  • Immunosuppressive disease, or you’re receiving immunosuppressive treatment
  • Cardiovascular disease
  • Hypertension
  • Chronic lung disease such as COPD or cystic fibrosis
  • Sickle cell disease
  • Neurodevelopmental disorders or other medically complex conditions such as genetic conditions or metabolic syndrome
  • Medical-related technology dependence such as a feeding tube
  • Other medical conditions or factors, such as race or ethnicity, can also put you at high risk for developing severe COVID-19 infection.
• Patients who are not eligible to receive monoclonal antibody treatment treatment are:
  • Asymptomatic patients
  • If your patient has been hospitalized for COVID
  • Has any other systemic infection
  • Has received oxygen therapy due to COVID or requires additional oxygen if on chronic oxygen therapy.
• Review the EUA patient fact sheet, including risks and benefits with the patient who will receive the monoclonal antibody treatment. Information can be found using the links below. 
  
  • Casirivimab/imdevimab
• Complete a Clinical Note that indicates which high-risk factors the patient has, as well as documentation that you reviewed risks and benefits with the patient.
• Complete the outpatient infusion referral order and fax, along with the following documentation, to the preferred Banner Health outpatient infusion site.