Managing COVID-19 Vaccination Costs

Overview

COVID-19 vaccines are being provided to all people in the United States at no cost to them.

Select groups of retail pharmacies are now involved in this COVID-19 vaccine initiative as part of the Federal Retail Pharmacy Program.

The program is a public–private partnership of 21 national pharmacy partners and networks of independent pharmacies representing over 40,000 pharmacy locations nationwide.

Those who qualify for the vaccine may contact a local pharmacy to receive their vaccinations.

This program is meant to speed up efforts to vaccinate the population more quickly.

And while this effort serves to expand opportunities for more people to get a COVID-19 vaccine more quickly, it does create some challenges for the pharmacies involved.

One of the key issues will be managing costs involved at the point of service.

COVID-19 vaccines are free to the public

While no pharmacy can charge patients for the vaccinations, providers can be reimbursed for an administration fee for giving someone the shot. Vaccination providers can bill the patient’s public or private insurance company or, for uninsured patients, request reimbursement from the Health Resources and Services Administration Provider Relief Fund. This is to ensure that no patient, regardless of health insurance coverage, pays out-of-pocket costs to receive a COVID-19 vaccine.

Many people continue to be confused about the cost of the vaccines. Any communication by retail pharmacies to notify individuals of available vaccines should include the message that the vaccines will be available AT NO COST TO THEM.

Reimbursement guidance for vaccine providers

The following guidance explains how to apply for reimbursement of administration fees associated with delivering the COVID-19 vaccine.

The COVID-19 vaccine doses are provided at no cost to providers or patients by the federal government, but providers are allowed to charge an administration fee. Recovering these administration fees requires providers to file for reimbursement.

Effective March 15, 2021, Medicare reimbursement for COVID-19 vaccine administration fees is approximately $40 per dose. Effective June 8, 2021, Medicare will reimburse an additional $35 per dose to administer COVID-19 vaccines in certain Medicare patients' homes. These reimbursement amounts apply to additional doses in certain immunocompromised persons administered on or after August 12, 2021.

The administration fee rates recognize the costs involved in administering the vaccine. These costs include required public health reporting, important outreach and patient education, and the time spent with patients answering any questions they may have about the vaccine. The rates are geographically adjusted. Reimbursement rates don’t apply to entities that are reimbursed for vaccines at reasonable cost.

Codes for filing for reimbursement are found at CMS.gov

In addition, people with Medicare pay nothing for their COVID-19 vaccines:

• No copayment/coinsurance 
• No deductible