JKJ is actively monitoring the COVID-19 vaccine development. Distribution is expected to be done in phases in order to prioritize initial populations, beginning with high-risk health workers, first responders and older adults living in long-term care facilities.
COVID-19 vaccinations will be available at pharmacies as well as doctors’ offices and other clinical sites of care. Any provider who is enrolled in the federal COVID-19 Vaccination Program can administer the vaccine. The vaccine will be covered under the medical or pharmacy benefit, depending on the site of administration. If the vaccine is administered by a pharmacy, it will be covered under the pharmacy benefit. If the vaccine is administered by a doctor’s office or another clinical site of care, it will be covered under the medical benefit. The initial vaccines will require administration in two doses.
The federal government will purchase all the initial limited supply of the vaccine and allocate vaccines to the states for prioritized distribution. It will be up to each of the states to determine, considering guidelines provided from the federal government, who to prioritize for the initial vaccine administration. During this time, the federal government will be covering the ingredient cost of the COVID-19 vaccine. However, insurers and plan sponsors will be required to cover the administration cost. The Medicare fee-for-service payment rate for vaccine administration for single-dose vaccine is $28.39; and, for a COVID-19 vaccine requiring a series of two or more doses, the initial dose(s) administration payment rate is $16.94 and $28.39 for the administration of the final dose. Section 3203 of the CARES Act generally requires issuers offering non-grandfathered group or individual health insurance coverage to cover any qualifying coronavirus preventive service, including a COVID-19 vaccine, without imposing any cost sharing requirements, such as a copay, coinsurance or deductible both in and out of network. Vaccine providers may not seek any reimbursement, including through balance billing, from a vaccine recipient.
Additional carrier updates and coverage information is available at the links below:
We understand that this is an evolving situation and further updates will be provided as information becomes available. If you have any questions, please complete the form below: