While the federal government is covering the cost of the COVID-19 vaccine for consumers during the public health emergency, some insurers may be left to foot the bill for providers' time administering the shot.
Although several insurers have said their members won't be charged for the vaccine or its administration, some providers expect to shoulder some costs as well.
"We greatly appreciate that the federal government is covering the cost of the vaccine, and the administration fee will be covered by individuals' health insurance, so the residents and staff will not have to pay," the American Health Care Association/National Center for Assisted Living said in an emailed statement.
The association said long-term care facilities will need additional federal funding.
"The cost to facilities is the staff needed to help set up the clinics, obtain consent, enter data in the medical record and track any complications. Also, there may be cost if any staff have to remain out of work after receiving the vaccine due to side effects. Therefore, we must ensure that public health officials prioritize long term care facilities with additional staff support," AHCA/NCAL said.
CMS has said it will cover the full cost of the vaccine and its administration for individuals covered under Medicare and Medicare Advantage plans in 2020 and 2021.
For all others, the federal Coronavirus Aid, Relief and Economic Security (CARES) Act requires all private insurers to cover the vaccine's price without cost-sharing among members during the public health crisis, even if an out-of-network provider administers the shot. The cost of the vaccine and its administration for those without health insurance will be covered by the Health Resources and Service Administration's Provider Relief Fund.
"Just as public payers, such as Medicare, are covering the cost of administration, so too should private health plans," Molly Smith, vice president of policy at the American Hospital Association, said in an email.
Washington, D.C.-based American Health Insurance Plan said that insurers will cover the cost of the Pfizer/BioNTech COVID-19 vaccine for members enrolled in most plans.
"Health insurance providers are proud of their commitment to ensuring that no one should hesitate to get tested or treated for COVID-19 because of concerns about costs," David Allen, director of communications and public affairs, wrote in an email to Modern Healthcare.
The Grand Rapids, Mich.-based Priority Health announced in early December that it planned to cover "medically necessary treatment" of COVID-19 through March 2021, presumably referring to administration of the vaccine. St. Louis-based Centene Corp. also said that it was planning to cover "medically necessary services for the administration" of the vaccine.
Blue Cross and Blue Shield of North Carolina pledged to cover the administration cost of COVID-19 vaccines that receive emergency use authorization by the Food and Drug Administration at no cost for all its members, both during the public health emergency and after.
"For all Blue Cross NC members, vaccine administration costs will be covered by the member's health plan," the company wrote in an email to Modern Healthcare. "After the public health emergency, we will cover the cost of the COVID-19 vaccine with no cost-sharing to members, as part of our routine preventative care and immunization benefits in accordance with federal laws and regulations."
That coverage extends to the healthcare workers and long-term care staff and residents who some of the first to receive the vaccine. Hospital clinical staff began receiving the Pfizer and BioNTech vaccine this week, and nursing home staff and residents will begin to be immunized starting Dec. 21.
Under the federal government's Pharmacy Partnership for Long-Term Care Program, which pairs long-term care facilities with either Walgreens or CVS for vaccine administration, the vaccine will be free but pharmacies will bill insurers for the costs of administering the vaccine, to reimburse for employees' time, Natasha Polster, vice president of pharmacy quality, compliance and patient safety at Walgreens, said during a webinar on vaccine rollouts Monday hosted by Argentum, a national association for professionally managed senior-living facilities.
CVS and Walgreens will be responsible for managing the vaccines and supplies, including syringes, needles and personal protective equipment; cold storage; administration of the vaccine and reporting vaccination data, providers, vaccination of staff and residents.
