Prime Therapeutics increases COVID-19 vaccine administration reimbursement rates to pharmacies beyond Medicare mandate

Pharmacies serving commercial and health insurance marketplace members will also be paid at the new CMS rate

March 25, 2021

EAGAN, Minn. – Pharmacies will soon be paid more to administer COVID-19 vaccinations, thanks to new, higher Medicare reimbursement rates recently set by the Centers for Medicare & Medicaid Services (CMS). Prime Therapeutics (Prime) and its Blue Plan clients took the CMS decision a step further and applied the higher rates to their Commercial and health insurance marketplace (HIM) lines of business as well.

Last week, the CMS increased reimbursement rates for administering COVID-19 vaccines to Medicare members to $40 for a single dose of any COVID-19 vaccine and $80 for a two-dose vaccine. Previously, reimbursement rates were $28.39 for a single-dose vaccine and $45.33 for a two-dose vaccine. Medicaid administration fees continue to be determined by each state. Prime will adjust the Medicaid reimbursement rates according to any revised guidance it receives from our Blue Plan clients. The CMS did not mandate the increase in other lines of business, but instead offered guidance to “consider prevailing market rates” for vaccine administration.

“Prime greatly values the role pharmacies are playing to help quickly deliver life-saving COVID-19 vaccines to millions of people across the country during this public health emergency,” said David Lassen, chief clinical officer at Prime. “These are extraordinary times, and this increase in reimbursement rates is the right thing to do to make sure our members have no barriers to access.”

Learn more about the recent CMS decision.

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