The commercialized (non-government supply) COVID-19 vaccine formulations are expected to be approved by the FDA on September 11, 2023. Health plans and Administrative Service Only clients will pay for the new vaccines. Members will continue to receive the vaccine at participating vaccine network pharmacies or physician offices, where available.
Like all other vaccines recommended under the Affordable Care Act mandate, they will be covered by Commercial and Health Exchange plans with $0 member cost share, when administered at an in-network pharmacy or participating provider. Consult your client’s plan for any group exceptions to the mandate.
The new commercialized vaccines will have different National Drug Codes (NDC) than the government vaccine supply. The expected cost of the COVID-19 vaccine will range from $120 to $130 per adult vaccine and $55 to $77 for children under 12, plus a $20 administration fee paid to the pharmacy or $20 - $30 administration fee paid to the physician’s office. The new vaccine will be available through the CarelonRx Broad Vaccine Network. We anticipate this will become a seasonal vaccine, like the flu vaccine.
The COVID-19 Vaccine Network created for pharmacies contracted to administer the government supply will be shut down and the existing government supply of vaccines will no longer be administered.
Oral antivirals (OAV) will be commercialized after the government supply has been exhausted. OAVs follow a different timeline than the vaccines. Lagevrio (molnupiravir) may be commercialized in the fourth quarter of 2023. Paxlovid is FDA approved in adults. It may be commercialized late in the first quarter of 2024.