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Depressors Pill News

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.