CMS Increases Medicare Reimbursement Rate for COVID-19 Vaccines

NCPA lauded the higher reimbursement rate in a statement.

The Center for Medicare and Medicaid Services (CMS) is increasing the Medicare payment amount for administering the COVID-19 vaccine, according to a statement from CMS.

Effective for COVID-19 vaccines administered on or after March 15, 2021, the national average payment rate for physicians, hospitals, pharmacies, and many other immunizers will be $40 to administer each dose of a vaccine. This nearly doubles the Medicare reimbursement rate from approximately $28 to $40 for the administration of single-dose vaccines and $45 to $80 for the administration of vaccines requiring 2 doses.1

The National Community Pharmacists Association (NCPA) issued a statement in support of the higher reimbursement rate.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,” NCPA CEO B. Douglas Hoey, RPh, MBA, said in the statement.2 “Many are administering the vaccine now, but some would lost money at the current reimbursement rate. 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.”

According to NCPA, the higher reimbursement rate will help to accelerate vaccine administration. The organization hopes to see this move replicated for Medicaid and private plans “to maximize the number of patients immunized as soon as possible.”2

These updates to the Medicare payment rate reflect new information about the costs involved in administering the vaccine for different types of providers and suppliers, and the additional resources needed to administer the vaccine, according to CMS.1

Reference

1. Biden-Harris Administration Increases Medicare Payment for Life-Saving COVID-19 Vaccine. News release. Centers for Medicare & Medicaid Services; March 15, 2021. Accessed March 15, 2021. https://www.cms.gov/newsroom/press-releases/biden-harris-administration-increases-medicare-payment-life-saving-covid-19-vaccine

2. Community Pharmacy Cheers Higher Reimbursement for COVID-19 Vaccines. National Community Pharmacists Association; March 15, 2021 [email]. Accessed March 15, 2021.