CMS Policy Aims to Ensure Access to COVID-19 Vaccines

The Centers for Medicare and Medicaid Services (CMS) announced this week that the coronavirus disease 2019 (COVID-19) vaccines approved by the FDA will be covered under Medicare as a preventive vaccine for free.

CMS’s Interim Final Rule with Comment Period (IFC) ensures “swift coverage of a COVID-19 vaccine by most private health insurance plans without cost sharing from both in and out-of-network providers during the course of the public health emergency (PHE),” CMS said in a news release.^1,2

Notably, CMS also said it is working to increase the number of health care providers that will administer a COVID-19 vaccine to Medicare beneficiaries when it becomes available.

“New providers are now able to enroll as a ‘Medicare mass immunizers’ through an expedited 24-hour process,” the agency said. “The ability to easily enroll as a mass immunizer is important for some pharmacies, schools, and other entities that may be non-traditional providers or otherwise not eligible for Medicare enrollment.”

“CMS’ new policy lowers barriers for COVID-19 vaccine access, when authorized or approved, by making it free for most Americans and providing necessary reimbursement to providers, including pharmacists, for administering the vaccine,” Ilisa Bernstein, PharmD, senior vice president for pharmacy practice and government affairs for the American Pharmacists Association, told Drug Topics®.

“CMS must continue working to ensure that any willing pharmacy is able to administer the vaccine, while fostering fair and equitable access to pharmacists’ patient care services across the country.”

The plan laid out by CMS ensures adequate reimbursement for administering the vaccine in Medicare, “while making it clear to private insurers and Medicaid programs their responsibility to cover the vaccine at no charge to beneficiaries”, CMS said.

“Under President Trump’s leadership, we have developed a comprehensive plan to support the swift and successful distribution of a safe and effective vaccine for COVID-19,” said CMS Administrator Seema Verma.² “As Operation Warp Speed nears its goal of delivering the vaccine in record time, CMS is acting now to remove bureaucratic barriers while ensuring that states, providers and health plans have the information and direction they need to ensure broad vaccine access and coverage for all Americans.”

CMS is also taking action to increase reimbursement for any new COVID-19 treatments that are approved or authorized by the FDA.

Anticipating the availability of new COVID-19 treatments, the IFC also establishes additional Medicare hospital payment to “support Medicare patients’ access to these potentially life-saving COVID-19 therapies,” CMS said.

References

1. Interim final rule with request for comments. Federal Register; October 28, 2020. Accessed October 30, 2020. https://www.cms.gov/files/document/covid-vax-ifc-4.pdf​

2. Trump Administration acts to ensure coverage of life-saving COVID-19 vaccines and therapeutics. News release. CMS; October 28, 2020. Accessed October 30, 2020. https://www.cms.gov/newsroom/press-releases/trump-administration-acts-ensure-coverage-life-saving-covid-19-vaccines-therapeutics