COVID-19 Resources

(From APhA- Added 3/19/21) In a major win for vaccinators and patients, CMS announced this week it will be increasing the administration rate and creating one standard rate for each COVID-19 vaccine administration for Medicare beneficiaries. Previously, the rates differed, depending on whether it was the first or second of a two-dose vaccine or if it was a single vaccine. CMS said that it will also work with states and private payers to increase their current payment rates.
All Medicare patients (including patients with Medicare Advantage plans) need to bring their red, white, and blue Medicare card for pharmacists and other providers to be able to bill Medicare part B for COVID-19 vaccine administration.
Here are the details:
  • Medicare
  • Single-Dose Vaccine: Starting on March 15, 2021, for single dose COVID-19 vaccines, Medicare will pay approximately $40 for its administration. 
  • Multi-Dose Vaccine: Starting on March 15, 2021, for COVID-19 vaccines requiring multiple doses, Medicare will pay approximately $40 for each dose in the series ($80 total)
  • Geographic Adjustments: The exact payment rate will continue to be geographically adjusted based on where the service is furnished with lower payments for lower cost areas and higher payments in higher cost areas. 
  • Medicaid
  • CMS to Pay 100% of State-Determined Vaccine Administration Rates: Beginning April 1, 2021, CMS will pay 100% for COVID-19 vaccine administration under state-determined Medicaid rates. This change might have implications for states with approved state plan amendments (SPAs), or pending SPAs, and states considering payment changes should contact CMS for technical assistance.
  • CMS to Work with States to Increase Medicaid Payment Rates: CMS intends to provide additional guidance to states in forthcoming updates to the CMS toolkit on implementation of the 100% federal coverage under Medicaid for COVID-19 vaccine administration. CMS also pledged to work with states to increase Medicaid administration payment rates to help reach underserved communities.
  • Private Plans:
  • CMS to Work with Other Federal Agencies that Regulate Private Plans to Ensure “Reasonable” Payment Rates that Reflect Increased Medicare Payment Rates. In light of CMS’s increased Medicare payment rates, CMS will expect commercial carriers to continue to ensure that their rates are “reasonable,” in comparison to prevailing market rates. CMS, along with the Departments of Labor and Treasury, already requires that most private health plans and issuers cover the COVID-19 vaccine and its administration, both in-network and out-of-network, with no cost sharing for patients during the public health emergency (PHE).
  • Uninsured: For individuals who are uninsured, pharmacists and other providers may submit claims for reimbursement for administering the COVID-19 vaccine to individuals without insurance through the HRSA Provider Relief Fund. CMS recently clarified that providers are not required to ascertain a patient’s immigration status in order to receive reimbursement from the fund.
  • PBM Updates *Added 3/25/20*
    • Express Scripts COVID-19 Signature Log Clarification
    • Express Scripts Communication from 4/30/20: *Added 5/1/20*

      "Signature log policy extended due to COVID-19

      04.30.2020
      Express Scripts would like to clarify that pharmacies are not required to obtain signatures from patients during this unprecedented pandemic, unless required by law. This policy was implemented on March 19, and was originally scheduled to remain in place until April 30. This policy has been extended and will be in effect until further notice.

      We understand that pharmacies will be servicing patients in unique ways and documentation could come in many forms, as an example but not meant to be all inclusive, documentation of that service may include: the pharmacist writes in a log book the prescription number and date of service, the cash register receipt that includes prescription numbers, a text message or email from the patient, a note on the hard copy, or an electronic annotation in your system. We understand that patient care is the number one priority and nothing in this notice should be construed to hinder servicing the patient.

      If you need a member’s specific prescription processing information or other help with a claim, please visit our Pharmacist Resource Center at https://prc.express-scripts.com.

       

      Thank you,

      Provider Outreach Team
      Express Scripts"

    • Express Scripts Re-credentialing changes related to COVID-19 *Added 4/8/20*
    • OptumRx Response to CMS Guidance Issued March 10, 2020 re: Medicare Advantage and Part D Plans Respond to COVID-19 (includes signature log clarification)
    • Express Scripts' Pharmacy Audits
    • CVS/Caremark Signature Log Update
    • OptumRx Communication from 3/26/20: *Added 3/27/20*  "Thank you for contacting OptumRx. OptumRx is partnering with our participating network pharmacies as we work together to battle COVID-19. As part of working together, OptumRx has temporarily suspended the mailing/shipping prohibition, waived the signature requirement for drugs mailed/shipped to a member and when a member picks-up the covered drug at a pharmacy. We understand and appreciate that the current focus of our network pharmacies is the well-being of our valued members and are an important part of the national health care response to mitigate the spread of COVID-19. Understanding the concerns during this national state of emergency and the need for our network pharmacies to focus on member/patient care, OptumRx has also suspended all on-site pharmacy audits as of March 16, 2020 and all desk audits as of March 23, 2020. Although we do not anticipate any material interference with a pharmacy serving the customers/members, please note that the above audit suspensions do not apply to fraud, waste or abuse investigations. Kind regards and stay safe! Heidi Lew Heidi C. Lew, Pharm.D. | OptumRx,Vice President, Pharmacy Network Audit
    • PBMs Stand With Rx Supply Chain to Help Patients Access Medications (PCMA Press Release) *Added 4/3/20*