COVID-19 Vaccine Spotlight: What You Need to Know

What are the latest developments with the COVID-19 vaccines? In this blog, we’ll discuss the current state of the COVID-19 vaccinations and what plan sponsors and members need to know.

The Impact of COVID-19

To date, more than 285,000 in the U.S. have died and more than 15 million people have been infected with the coronavirus. Yet amidst these staggering numbers, there is positive news with the accelerated development of several vaccines that appear to be highly effective at preventing, or significantly reducing the severity of, COVID-19.

Here’s what you need to know.

vaccine approvals

Vaccine manufacturers Moderna, Pfizer, and AstraZeneca have all reported positive results with their vaccine trials. Moderna and Pfizer are in the process of applying for the U.S. Food and Drug Administration’s (FDA) Emergency Use Authorization (EUA). Today the FDA’s advisory vaccine committee will be meeting to review the EUA applications for the Pfizer vaccine. If the proceedings go as planned, this vaccine could be available for distribution as early as December 15.

On December 8, FDA officials announced the data from the Pfizer coronavirus vaccine trials was consistent with recommendations put forth by the agency for EUA. While two doses of the vaccine were “highly effective” in preventing confirmed cases of COVID-19, it also added that data appeared to show that the vaccine provided more than 50% immunity after only one dose.¹

If authorized, Pfizer expects to have up to 50 million doses and Moderna up to 20 million doses available by the end of the year.

pharmacy participation

To participate in administering COVID-19 vaccines, pharmacies, retail clinics, providers and any other site must sign an agreement with the U.S. government. However, because of the stringent storage requirements of some COVID-19 vaccines, only 60% of sites that typically administer vaccines will be able to store and provide COVID-19 vaccinations.

Pharmacy chains that have agreed to participate in administering the COVID-19 vaccine include Costco, CVS, Rite Aid, Walgreens and Walmart. A more comprehensive list of chain and community pharmacies can be found here.

cost

In the initial stages, the federal government is paying for the vaccine cost.

However, vaccine providers will be able to charge a fee to administer the vaccine. CMS has set the reimbursement rate for vaccine administration at $16.94 for the initial dose and $28.39 for the second dose in the series. Navitus’ standard reimbursement will align with the CMS fee schedule.

For Medicare, the vaccine will be covered under Medicare Part B.

During the current public health emergency, coverage must be provided with no cost sharing. Those who administer the vaccine to people without insurance or whose insurance does not provide coverage can request reimbursement for the administration of the vaccine through the Health Resources and Services Administration (HRSA) Provider Relief Fund. ²

navitus response

We believe in a connected pharmacy experience that improves health, lowers cost, and eliminates complexity. We have assembled a team of experienced leaders across our entire organization to ensure the smooth rollout of the COVID-19 vaccines once they become available.

We support the goal of providing vaccinations to a significant proportion of the population and realize that comprehensive vaccination is an essential step to getting COVID-19 under control.

Furthermore, our goal is to make the vaccine(s) available to as many of our members as possible and will recommend the vaccine(s) be added to clients’ formularies unless specifically told not to.

We recognize that with the nationwide rollout to vaccinate millions of Americans, there may be unscrupulous players looking to take advantage of the situation. Navitus has a robust Fraud, Waste and Abuse team who will be closely monitoring vaccination claims for suspicious activity.

Next Steps

We will continue to monitor the vaccine activity and will provide timely updates as more information becomes available.

1. Pfizer Shot Effective, Safe, FDA Staff Says Before Meeting. Bloomberg. https://www.bloomberg.com/news/articles/2020-12-08/pfizer-shot-effective-safe-fda-staff-concludes-before-meeting. Published December 8, 2020. Accessed December 9, 2020.
2. COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured. Health Resources & Services Administration. https://www.hrsa.gov/CovidUninsuredClaim#:~:text=Health%20care%20providers%20who%20have,rates%2C%20subject%20to%20available%20funding. Accessed December 9, 2020