As part of PrescribeWellness’ ongoing commitment to keep its pharmacy clients up to date and in the know with all things related to the life-saving COVID-19 vaccine, we wanted to make sure you are aware of some important news that recently came out of Washington: On March 15th, the Centers for Medicare & Medicaid Services (CMS) announced it will increase the Medicare payment amount for administering COVID-19 vaccines.
This is also great news for community pharmacy. Why? Well, higher payment rates means providers, like you, will now have the financial support to bolster your vaccination efforts and increase the number of daily vaccines administered – key to accomplishing the larger national goal of getting all Americans vaccinated as soon as possible. A goal that is even more attainable in the wake of the current White House Administration’s proclamation that as of April 19th, all adults (16 and older) in the United States are officially eligible for the COVID-19 vaccine.
Please read on as we provide you a brief overview of the new Medicare payment rates broken down by the numbers, as well as by payer coverage.
Medicare Payments – by the numbers
Per CMS, pharmacies will now receive $40 (national average payment rate) for each dose of a COVID-19 vaccine administered on or after March 15, 2021. Make no mistake, this payment hike is significant – single-dose vaccine payments have jumped from approximately $28 to $40 and COVID-19 vaccines requiring two doses have gone from $45 to $80.1
CMS has updated its toolkits for providers, states, and insurers to help the health care system swiftly administer the vaccine in accordance with these new Medicare payment rates. Please note: exact Medicare payment rates for COVID-19 vaccines depend on the type – and geography – of the entity administering them.
Coverage – by the payers
It is important to note that providers may not charge patients for administering COVID-19 vaccines which were received at no cost from the federal government. That said, there are some key points of coverage differentiations across the major programs and payers, so here is a brief breakdown:
- Medicare: Beneficiaries pay nothing for COVID-19 vaccines and there is no applicable copayment, coinsurance or deductible.
- Medicare Advantage (MA): For 2020 and 2021, Medicare will pay providers directly for the COVID-19 vaccine and its administration for beneficiaries. MA plans are not responsible for paying providers to administer the vaccine to MA enrollees during this time.
- Medicaid: Must provide vaccine administration with no cost sharing for nearly all beneficiaries during the public health emergency (PHE) and at least one year after it ends.
- Private Plans: Most private health plans and issuers are required to fully cover the COVID-19 vaccine, and its administration, during the public health emergency (PHE) – in and out-of-network.
- Uninsured: Providers may submit claims for reimbursement for administering the COVID-19 vaccine to individuals without insurance through the Health Resources & Services Administration (HRSA) Provider Relief Fund.
Want to learn more about COVID-19 vaccine administration? You can always visit the PrescribeWellness COVID-19 Vaccine Resource Center, which is committed to providing you with up to date and need-to-know information surrounding COVID-19 vaccine requirements, reporting, and reimbursement.