Articles | December 10, 2020
As we anticipate emergency FDA approval of the new COVID-19 vaccines, we've developed some guidance on what plan sponsors may need to do next.
If you have any questions at all, please don't hesitate to contact us.
Have questions about these action items? Contact us.
The Medicare fee schedule (for the administration cost) is:
We expect most health insurers/PBMs/TPAs to charge similar fees to administer the vaccine.
We also expect a wide range of vaccination rates for each group, based on survey results as to the likelihood adults will get vaccinated.
But we should expect the plan cost impact to be under 1% of total medical plan costs for 2021.
We suggest you contact your vendor account manager to confirm administrative fees they will pass on to plans and pharmacies or other health care facilities.
Self-insured plan sponsors will also need to determine whether to cover this in their medical or pharmacy benefits.
Segal is recommending coverage in both settings to maximize access and minimize member confusion. When covered in the medical benefit, there may also be an office visit charge if received in an office setting.
Plans should review current plan documents detailing how other vaccines are currently covered and determine if any amendments to plan documents may be required.
Please work with your compliance expert to review plan documents. Grandfathered plans are not required to cover the vaccine (with or without cost sharing), but will likely choose to do so (or the terms of their plan may require them to do so), and must make similar coverage decisions to non-grandfathered plans.
Because of the handling issues (extreme cold storage for some vaccines) and other distribution issues, the vaccine is likely to be provided by major pharmacy chains and hospital based outpatient facilities.
We expect that administration sites will vary by state and will change over time as new vaccines are approved (e.g. some vaccines have less stringent handling requirements).
This page is for informational purposes only and does not constitute legal, tax or investment advice. You are encouraged to discuss the issues raised here with your legal, tax and other advisors before determining how the issues apply to your specific situations.
Don't miss out. Join 16,000 others who already get the latest insights from Segal.