NCPA Applauds Higher Medicare Reimbursement for COVID-19 Vaccines

The Medicare payment amount for administering the COVID-19 vaccine is increasing, according to a statement from the Centers for Medicare and Medicaid Services (CMS). The new national average payment rate will be $40 for each dose of the COVID-19 vaccine, with the new amount becoming effective for vaccines administered on or after March 15, 2021, by physicians, hospitals, pharmacies, and other immunizers.¹

The new payment rate increases the payment to immunizers from approximately $28 to $40 for the administration of single-dose vaccines and approximately $45 to $80 for the administration of COVID-19 vaccines requiring 2 doses.¹

National Community Pharmacists Association (NCPA) CEO B. Douglas Hoey, MBA, explained in NCPA’s statement in response to this action that the increase in payment is critical for the efficacy of the vaccination program across the country.²

“The COVID-19 vaccine is only as effective as the distribution system. There are more than 21,000 small business community and long-term care pharmacies in the country. Many are administering the vaccine now, but some would lose money at the current reimbursement rate,” Hoey said in the NCPA statement.²

Additionally, the payment increase reflects findings from new data that were made available highlighting the actual costs involved in the administration of COVID-19 vaccines for different types of providers and suppliers, as well as the additional resources necessary to ensure the vaccine is administered safely and appropriately at each site.¹

For this reason, the exact payment rate for administration of each COVID-19 vaccine dose may change from site to site, as the payment amount will take into consideration the type of entity administering the vaccine and where the site is based, according to the CMS statement.¹

The increase in payment amount is specifically intended to allow immunizers to more readily establish new or grow existing vaccination sites, conduct patient outreach and education, and hire additional staff, which have specific costs associated with the type of entity and the site location.¹

“Increasing the Medicare rate from an average of $23 per vaccination to $40 per vaccination allows community pharmacists to recoup the additional personnel, administrative, and capital expenses associated with immunizing their patients,” Hoey said in the NCPA statement.²

CMS is also updating the available toolkits for providers, states, and insurers in an effort to support the health care system more broadly with the new Medicare payment rates. These resources were updated in order to expand the number of providers that can administer the vaccine, ensure adequate payment for vaccine administration to Medicare beneficiaries, and establish clearly that all patients, regardless of whether they are covered by private insurance, Medicare, or Medicaid, should not need to pay cost-sharing in order to receive COVID-19 vaccine.¹

“This is an important, positive decision that will accelerate the vaccine administration program and get shots in arms more quickly,” Hoey said in the NCPA statement. “We would like to see it replicated for Medicaid and private plans to maximize the number of patients immunized as soon as possible.”²

REFERENCE

• Centers for Medicare & Medicaid Services. Biden-Harris Administration Increases Medicare Payment for Life-Saving COVID-19 Vaccine. Published March 15, 2021. https://www.cms.gov/newsroom/press-releases/biden-harris-administration-increases-medicare-payment-life-saving-covid-19-vaccine. Accessed March 15, 2021.
• Community Pharmacy Cheers Higher Reimbursement for COVID-19 Vaccines. Alexandria, VA: National Community Pharmacists Association; March 15, 2021. [Email] Accessed March 15, 2021.