Coronavirus: CMS releases plan for vaccine patient price, reimbursement

The Centers for Medicare and Medicaid Services (CMS) is laying the groundwork for the widespread release of a COVID-19 coronavirus vaccine by releasing an interim final rule with comment period (IFC) with information on out-of-pocket patient costs and physician reimbursements.

According to a news release, any vaccine which is authorized by the U.S. Food and Drug Administration (FDA) through an emergency use authorization (EUA) or a biologics license Application (BLA) will be covered by Medicare and most private insurers at no additional cost to the patient.

“As Operation Warp Speed nears its goal of delivering the vaccine in record time, CMS is acting now to remove bureaucratic barriers while ensuring that states, providers and health plans have the information and direction they need to ensure broad vaccine access and coverage for all Americans,” CMS Administrator Seema Verma says in the release.

In order for physicians to receive free COVID-19 vaccines from the federal government, they will be prohibited from charging patients for administering them, the release says.

Medicare payment rates for physicians who administer a vaccine will be $28.39 for a single-dose vaccine. For vaccines which require multiple dose administrations, the initial dose administration rate will be $16.94, and the rate will be $28.39 for the final dose. Rates will be geographically adjusted and will recognize the costs incurred by administering the vaccine including public health reporting, outreach, and patient education, the release says.

The agency is urging private insurers to use information from the interim rule to develop their own reimbursement policies, according to the release.

The interim rule will be displayed at the Federal Register as soon as possible and has an immediate effective date, with a 30-day comment period. It can be downloaded here. More information can be found on the fact sheet here.​