This is an excerpt from a recently published study in AJMP Focus, “State Medicaid Coverage and Reimbursement of Adult Vaccines Administered by Physicians and Pharmacists as of 2022”, which was supported by Merck. Click here to read the full article.

Introduction

Effective October 2023, federal law requires Medicaid programs to cover all recommended adult vaccines administered by physicians with no cost sharing for all eligibility groups. However, uniform coverage does not always translate to optimal uptake. Rather, other factors like Medicaid reimbursement rates influence vaccine access and ultimately patient uptake. This study reviewed Medicaid policies to understand vaccine coverage and reimbursement, for both physicians and pharmacists, in all 50 U.S. states, Washington, D.C., and Puerto Rico (collectively, “states”).

Methods

Between March and September 2022, the researchers reviewed states’ public Medicaid policies regarding adult vaccines, focusing on the service of injectable vaccine administration and three products: hepatitis A (HepA), 9-valent human papilloma virus (9vHPV), and 23-valent pneumococcal polysaccharide (PPV23).

Results

Among 50 states with available data, 7 (14%) restricted Medicaid coverage for HepA, 9vHPV, and/or PPV23 administered by physicians and 15 (30%) did so for pharmacists. Median physician reimbursement was below the private sector rate for HepA (89%) and 9vHPV (94%), but above for PPV23 (108%). Median physician reimbursement for vaccine administration during an office visit was $11.86; the median pharmacist administration fee was $10.67.

Conclusions

Although federal law now requires all state Medicaid programs to cover, without cost sharing, all recommended adult vaccines administered by physicians, equitable vaccine access may be hindered by state coverage restrictions for pharmacists and by relatively low reimbursement rates relative to Medicare and commercial coverage for both physicians and pharmacists.

Click here to read the full article.