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Medicare, Medicaid will cover costs of future COVID-19 vaccine under new policy

Nathaniel Weixel | 10/28/2020 | The Hill

Medicare will cover any potential coronavirus vaccine for free, under a new Trump administration policy officially announced Wednesday.

The new rule from the Centers for Medicare and Medicaid Services (CMS) means any vaccine that receives Food and Drug Administration (FDA) authorization will be covered under Medicare as a preventive vaccine at no cost to beneficiaries, which is a change from current policy.

The vaccine will be given to providers to administer free of charge, and Medicare will reimburse for the cost of physically injecting someone with the vaccine. If two doses are required, Medicare will pay more for the second. 

Congress in March passed the CARES Act, coronavirus relief legislation, which aimed to make sure all vaccines were covered free of charge. But the Medicare program's rules about emergency use drugs prevented that.

The policy also implements provisions of the CARES Act that calls for most private insurers to cover a COVID-19 vaccine under most private health insurance plans without cost sharing from both in- and out-of-network providers during the course of the public health emergency.

For individuals who are uninsured, providers will be able to be reimbursed for administering the COVID-19 vaccine to individuals without insurance through the Provider Relief Fund.

The new policy also tells state Medicaid agencies to provide vaccine administration with no cost sharing for most beneficiaries during the public health emergency. 

Following the public health emergency, depending on the population, states may have to "evaluate cost sharing policies and may have to submit state plan amendments if updates are needed," according to the rule.

The administration earlier this month announced an agreement with retail pharmacies CVS and Walgreens to help distribute an eventual coronavirus vaccine to long-term care facilities like nursing homes, with no out-of-pocket costs.

There are currently four vaccines in final stage trials, but even if a company files for emergency authorization in the next month, it likely won't be granted until early next year.

For new therapies that have yet to be authorized, such as antibody drugs delivered in hospitals, CMS said it is restructuring how it reimburses hospitals, so they can get reimbursed for all the costs associated with delivering them.

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Categories: Medicaid Watch