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.
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.