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COVID-19 Vaccine Updates

As the COVID-19 vaccine becomes widely available, we are here to help answer your questions about cost, availability and coverage.

Important details about the Covid Delta Variant from Michael Einodshofer, RPh, MBA, Executive Vice President, Chief Pharmacy Officer, Maxor National Pharmacy Services – 7/23/2021

What is different about the Delta variant?

All viruses naturally have genetic changes over time. 

The genetic changes the virus has undergone has made it more contagious.  In fact, it is estimated that Delta is more than twice as contagious as the original Covid strain1.  Some research has shown even higher numbers.

I’ve heard a vaccinated person can still get Covid.  Is this true? 

A vaccinated person is less likely to test positive for Covid, but it is possible.2

However, it is incredibly important to understand why this happens.  Please keep reading!

And it is just as important to know that a vaccinated person is far less likely to have serious disease, hospitalization, or die due to Covid complications. In recent weeks, upwards of 99% of all Covid-related hospitalizations in the US are unvaccinated individuals.

Does the vaccine protect me against the Delta variant?

Yes.

Why is there a chance someone may test positive after they’ve been fully vaccinated?

All Covid vaccines initially cause the body to produce antibodies that help the immune system clear virus from your body if the virus is contracted.  

People get sick when viruses like Covid are given a chance to multiply in the body faster than the body can eliminate the virus.  Like how a key fits a lock, antibodies are “custom designed” by the body specific to each potential virus (and other unwanted intruders) that threaten the body.  

Having antibodies against a potentially dangerous virus like Covid is important, but the circulating antibodies your body creates after receiving the vaccine (or prior infection) naturally fade over time in the bloodstream.

However, the immune system is much more complex than simply fighting infections with the antibodies in your bloodstream.  Certain cells in your body are trained to “remember” a foreign intruder like a virus, just in case it shows up again in the future.  Vaccines train these same cells to recognize the actual virus should it be encountered in the future.

These trained cells are immediately called into action to start producing antibodies when it detects the actual virus.  This process allows the body to more quickly mount an immune response and fight the virus much quicker than reacting to a new virus that it has never encountered before.

So, the virus can find its way into a vaccinated person just like an unvaccinated person, but the vaccinated person’s body will respond stronger and much quicker to fight the unwelcome viral intruder.

This is why some vaccinated people, and those with prior infections can still test positive for Covid, but they have significantly less risk of hospitalization or death.   Basically, vaccinated people are better prepared for the fight to eliminate the virus.

In addition, it is believed that vaccinated individuals also transmit less virus if they do become infected, and tend to be asymptomatic or have a shorter duration of mild disease (similar to a cold).

What’s Next?

Getting vaccinated is your choice, and we hope whatever decision you make is a well-informed one.  We don’t know what the next 3-6 months will bring, but am extremely confident that areas with higher vaccination rates will see less infections and less hospitalization that those with lower vaccination rates.  I believe we will be living with Covid for years to come, similar to many other infectious diseases that lurk in the background of our daily lives. Lucky for us, we have a safe and effective way to significantly lower your risk of experiencing complications from this disease.

Mike Einodshofer, RPh, MBA

Chief Pharmacy Officer, Executive Vice President

  1. https://www.yalemedicine.org/news/5-things-to-know-delta-variant-covid
  2. https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html

Member Frequently Asked Questions

How much will the vaccine cost?

  • If submitted to MaxorPlus, you will pay $0 to receive your vaccine.

Where and when can I receive the vaccine using MaxorPlus coverage?
  • MaxorPlus will accept claims from any contracted pharmacy for the COVID-19 vaccine. No network restrictions apply.
  • Go to the CDC’s VaccineFinder page to locate sites near you.

What if the vaccine is not covered by my pharmacy benefit?

You will pay $0 for the COVID-19 vaccine, regardless of your pharmacy benefit plan’s design.

How is the vaccine administered?
  • Currently, three vaccines are authorized by the FDA:
    • Pfizer Vaccine: 2 doses (second dose 21 days after first dose)
    • Moderna Vaccine: 2 doses (second dose 28 days after first dose)
    • Johnson & Johnson Vaccine: 1 dose

Client/Plan Frequently Asked Questions

How much will the vaccine cost to plans?
  • The cost of the COVID 19 vaccine itself is being paid for by the US Government while the administration fees will be covered by Plan Sponsors. 
  • The initial Pfizer and Moderna vaccines will require two doses. The administration fee for the first dose will be approximately $17, and the second dose’s administration fee will be approximately $28. 
  • The single Johnson & Johnson dose administration fee will be approximately $28.
  • Members will pay $0 cost sharing, regardless of their plan design.
  • As of March 15, the Centers for Medicaid and Medicare (CMS) increased their reimbursement rate for the COVID-19 vaccine to $40 per shot.

What will the MaxorPlus plan cover?
  • All plans are configured in the adjudication system to allow for members to receive the COVID-19 vaccines at $0 cost share.
  • MaxorPlus will accept claims from any contracted pharmacy for COVID-19 vaccines.
  • MaxorPlus will not be restricting the network for this vaccine.