Mar 23 2021

Federal Government Increases Medicare Reimbursement Rate for COVID-19 Vaccines

Effective March 15, 2021, the Centers for Medicare & Medicaid Services (CMS) increased the Medicare payment rate for COVID-19 vaccines to $40 for each dose administered. This comes as good news for pharmacists currently engaged in vaccine administration who have largely been operating at a loss.

Prior to the CMS's mid-March adjustment, the Medicare payment rate for a single-dose vaccine, including the second dose in a two-dose series, was $28.39. The payment rate for the initial dose of a two-dose series was $16.94, with all rates subject to geographic adjustment.

According to CMS, the increase, which more than doubles the reimbursement rate for first doses, "reflects updated information about the costs involved in administering the COVID-19 vaccine for different types of providers and suppliers, and the additional resources necessary to ensure the vaccine is administered safely and appropriately."

Pharmacy organizations, including the National Community Pharmacists Association (NCPA), were quick to praise the CMS action. "Increasing the Medicare rate from an average of $23 per vaccination to $40 per vaccination allows community pharmacists to recoup the additional personnel, administrative, and capital expenses associated with immunizing patients," said NCPA CEO B. Doug Hoey. "This is an important, positive decision that will accelerate the vaccine administration program and get shots in arms more quickly," he added. 

Hoey suggested that at the original reimbursement rate, many pharmacists who stepped up to administer COVID-19 vaccinations were actually losing money. Such was the experience of one Brooklyn, NY pharmacist who was profiled recently by the Baltimore Sun. The pharmacist found himself with several hundred doses of surplus vaccines but, because of strict distribution requirements, was unable to offer them to patients who did not meet current eligibility requirements.

This is where PrimeRx™ pharmacy software vaccination process for COVID-19 compliance guidelines, enrollment, billing, and reporting will in to play.

To help pharmacists meet this challenge, Micro Merchant Systems has made several enhancements to the PrimeRx™ pharmacy management system. With these functionalities, pharmacies can rely on PrimeRx™ for automated management of all COVID-19 vaccine-related workflows, including patient enrollment and scheduling, billing, and reporting.

We've made the process as user-friendly and straightforward as possible. To begin, you will need access to the following platforms:

  • PrimeRx™ version This is the most recent version of PrimeRx™ that includes software upgrades designed to accommodate vaccine requirements.
  • PrimeDMS™. Our document management module that integrates directly with PrimeRx™.
  • Jotform. A third-party online form platform that allows patients to enter required information and schedule their vaccines. Pharmacies can integrate directly with JotForm via PrimeDMS™.
  • Google Drive. Pharmacies will need to create their own account in Google Drive in order to transmit completed JotForm documents to the PrimeDMS™ document queue. From the PrimeDMS™ document queue, a patient's information can be transferred to PrimeRx™ to start a new prescription.
  • Tabula Rasa Healthcare (TRHC) & Script Management Partners (SMP).  A third-party solution that ensures automatic COVID-19 vaccine reporting to state and local immunization information systems (IIS).

As the Sun reported, rather than let the vaccines go to waste, the pharmacist proactively traveled to various senior housing complexes in his community to locate eligible patients who were either homebound or struggling to find appointments. The pharmacist's innovative approach allowed him to reach members of the community who otherwise might not have had access to the vaccine, while also helping to offset the pharmacy's out-of-pocket costs.

As the pharmacist explained, many pharmacies have faced "financial strains" from the vaccination rollout, caused by having to invest thousands of dollars in equipment such as freezers and portable refrigerators, as well as the additional hours of staff time required for vaccine administration and management.

The CMS's revised reimbursement strategy will certainly help pharmacists across the nation who, like this individual, are going above and beyond every day to deliver vaccines to senior citizens and infirm patients. However, the new reimbursement rate applies only to Medicare patients, meaning pharmacists are still subject to the original, lower rates for non-Medicare patients.