COVID-19 Vaccine Coverage & Costs – What Employers Should Know

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Two vaccines have now been approved – one by Pfizer and the other by Moderna. Here are the basic facts:

  • 2-dose regimen. Patients will receive one injection followed by another a few weeks after.
  • Both are 94-95% effective, according to the manufacturer press releases.
  • Both require ultra-cold storage with special shipping and handling requirements.
  • The distribution will be directed by the States and Federal Government with the aid of the Department of Defense.
  • Phase 1 distribution is targeting health care workersessential workers, and patients at higher risk of severe disease including patients in LTC facilities. Phase 2 distribution will be for the masses and other critical populations.
  • There are continuing discussions which aim to further delineate essential workers into frontline vs non-frontline.
  • We estimate phase 1 to continue through spring of 2021 with phase 2 overlapping or starting shortly thereafter.

There is a third vaccine by Astrazeneca/Oxfordcurrently under review by the regulatory agencies. There are high hopes for this vaccine due to its lower cost and easier storage requirements.

Employer & Employee Cost

The ingredient cost of the vaccine will initially be covered by the federal government. The vaccine administration costs will be the responsibility of the employer’s health planThe cost to administer the vaccine will be approximately $45 per patient. This cost may be broken up, depending on whether the patient receives a 2-dose or 1-dose regiment. The number of doses is dependent on the specific vaccine per the FDA emergency approval.

Pharmacy or Medical Benefit?

Our general recommendation for most employers is to include coverage of COVID vaccines under the pharmacy benefit and to do so at $0 cost to plan participants. However, COVID vaccine claims may also flow through the medical benefit. These costs should be similar to the CMS fee schedule. It is best to consult with your consultant to determine the best plan of action for your business.

COVID-19 Vaccine Coverage & Costs – What Employers Should Knowhttps://www.cbiz.com/Portals/0/BiReskinImages/Hero Images/hero_image_9.jpg?ver=2020-11-24-160619-250Two vaccines have now been approved – one by Pfizer and the other by Moderna. Here are the basic facts.2020-12-23T17:00:00-05:00Two vaccines have now been approved – one by Pfizer and the other by Moderna. Here are the basic facts.Employee ManagementEmployee BenefitsEmployee Benefits ComplianceCOVID-19Yes