WASHINGTON — Less than a week has passed since the FDA and CDC authorized the newest versions of Moderna's and Pfizer's COVID-19 vaccines. Pharmacies are already seeing a lot of interest, but not all the patients who want to roll up their sleeves leave with renewed protection against the virus.
One viewer told us she got turned away over the weekend by her pharmacist. She said the pharmacist explained that Medicare was not covering the new vaccines, but if she tried again in two weeks, she might have better luck.
QUESTION
Does Medicare cover the new versions of the COVID-19 vaccine?
SOURCES
Chiquita Brooks-LaSure, Administrator of the Centers for Medicare and Medicaid Services
ANSWER
As with previous versions of the vaccines, Medicare does cover the new shots.
WHAT WE FOUND
Federal regulators gave emergency authorization to two updated versions of the COVID-19 vaccine in an effort to better match the version of the virus in circulation this fall and winter.
While the national public health emergency was in effect, the federal government paid for and distributed all doses. After it ended in May, providers continued to use doses already paid for by the federal government, with the understanding that COVID-19 vaccines would eventually transition to a market-based model.
Since the updated formulas are new to the market, they are the first to not be completely covered by Washington. Instead, private and government insurance will pay for them as they do with other vaccines.
The Medicare.gov website says COVID-19 vaccines fall into the category of preventative services covered by Part B.
Chiquita Brooks-LaSure, the Administrator of the Center for Medicare and Medicaid Services, sent a letter in July to Medicare plans, private insurance companies, and state agencies, saying that government plans and most private plans must pay for authorized vaccines without cost-sharing such as co-pays or deductibles.
A CVS spokesperson said in an emailed statement that, "some payers are still updating their systems and may not yet be set up to cover the updated COVID-19 vaccines. If this happens, our pharmacy teams can help patients schedule an appointment for a later date."
While the CDC gave its final authorization to the new vaccines on Sept. 13, Moderna announced in a press release two days prior, following the FDA's vote, that it would begin shipping doses to providers. Some CVS locations in Washington D.C. offered vaccination appointments one day after the CDC added its authorization.
A representative for Walgreens wrote in an emailed statement, "COVID-19 vaccines will continue to be available at no cost to the public. The cost will either be covered by insurance or government assistance programs, such as the CDC’s Bridge Access Program. Walgreens remains focused on driving equitable and convenient access to life-saving vaccines. We encourage everyone to bring insurance information to their appointment if available but will not turn away those (whose) insurance does not cover it. Walgreens is committed to ensuring everyone who is eligible and wants a vaccine receives one."
