The Centers for Medicare and Medicaid Services released an interim final rule yesterday (10/28) stating that Medicare will cover vaccines that receive FDA authorization. This includes vaccines that receive emergency use authorization, at no cost to beneficiaries.
There is an international race between drug development companies to create a safe Covid-19 vaccine. Previously reported by the Wall Street Journal, Medicare would not cover drugs approved under the FDA’s emergency use designation.
CMS Administrator Seema Verma promised policy changes:
“We’ve figured out a path forward. It’s clear Congress wants to make sure Medicare beneficiaries have this vaccine and that there isn’t any cost sharing.”
There will be no out-of-pocket cost for the vaccine for Medicare and Medicare Advantage beneficiaries, and “surprise or balance billing for vaccine costs is strictly prohibited,” she said.
Under the new rule, hospitals would qualify for those outlier payments when they treat patients with new therapeutics approved for Covid-19, even if their costs for providing the treatment do not reach the $30,000 threshold.
CMS has provided toolkits for Medicaid agencies to help guide providers as they administer and bill for the coronavirus vaccine. The interim final rule will be available on the federal register for a 30-day comment period.