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January 19, 2021

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COVID FAQ'S

Are COVID-19 vaccines covered under the medical or pharmacy benefit?

Anthem health plans cover the COVID-19 vaccine under the medical or pharmacy benefit, depending on the site of administration. If the vaccine is administered by a pharmacy, it will be covered under the pharmacy benefit. If the vaccine is administered at a doctor’s office or another clinical site of care, it will be covered under the medical benefit. 

Will Anthem waive cost shares on treatments for potential complications from a COVID-19 vaccine? 

No, Anthem will not waive cost shares on treatments for potential complications from a COVID-19 vaccine.

Which retail pharmacies will have access to the vaccines?

Below is a list of retail pharmacies that have partnered with HHS on Nov. 6 to provide access to vaccines when they become available. The list includes pharmacies across the nation, with approximately 60 percent of all US pharmacies to date. 

· Albertsons Companies, Inc. (Osco, Jewel-Osco, Albertsons, Albertsons Market, Safeway, Tom Thumb, Star Market, Shaws, Haggen, Acme, Randalls, Carrs, Market Street, United, Vons, Pavilions, Amigos, Lucky’s, Pak n Save, Sav-On)

· Costco Wholesale Corp.

· CPESN USA, LLC

· CVS Pharmacy, Inc. (Long’s)

· Good Neighbor Pharmacy and AmerisourceBergen Drug Corporation’s PSAO, Elevate Provider · Health Mart Systems, Inc. · H-E-B, LP · Hy-Vee, Inc.

· LeaderNET and Medicine Shoppe, Cardinal Health’s PSAOs · Managed Health Care Associates (MHA) · Meijer Inc.

· Publix Super Markets, Inc.

· Retail Business Services, LLC (Food Lion, Giant Food, The Giant Company, Hannaford Bros Co, Stop & Shop) · Rite Aid Corp.

· The Kroger Co. (Kroger, Harris Teeter, Fred Meyer, Frys, Ralphs, King Soopers, Smiths, City Market, Dillons, Marianos, Pick-n-Save, Copps, Metro Market)

· Topco Associates, LLC (Big-Y Pharmacy and Wellness Center, Brookshire’s Pharmacy, Super One Pharmacy, FRESH by Brookshire’s Pharmacy, Coborn’s Pharmacy, Cash Wise Pharmacy, MarketPlace Pharmacy, Hartig Drug Company, King Kullen, Food City Pharmacy, Ingles Pharmacy, Raley’s, Bel Air, Nob Hill Pharmacies, Save Mart Pharmacies, Lucky Pharmacies, SpartanNash, Price Chopper, Market 32, Tops Friendly Markets, ShopRite, Wegmans, Weis Markets, Acme Fresh Markets)

· Walgreens (Duane Reade)

· Walmart, Inc. (Sam’s Club)

· Winn-Dixie Stores Inc. (Winn-Dixie, Harveys, Fresco Y Mas)

Will the federal government be paying for the cost of the COVID-19 vaccines and their administration?

At least in the short term, the cost of the vaccines, and ancillary supplies will be funded by HHS. The CDC has indicated the vaccine purchased with US taxpayers’ dollars will be available at no cost. 

CMS, along with the Departments of Labor and the Treasury, require that fully-insured and self-funded plans cover the vaccine and vaccine administration with no member cost-sharing for the duration of the public health emergency.

HHS does not cover the costs of vaccine administration for commercial or Medicaid members but they will cover administration for Medicare beneficiaries, including Medicare Advantage members. Anthem health plans will cover those costs for fully-insured, employer-sponsored customers and many Medicaid members unless otherwise directed by a state. Self-insured customers will be financially responsible for the administration fees.

CMS has announced the fees to administer the vaccines at pharmacies range from

Are COVID-19 vaccines covered under the medical or pharmacy benefit?

Anthem health plans cover the COVID-19 vaccine under the medical or pharmacy benefit, depending on the site of administration. If the vaccine is administered by a pharmacy, it will be covered under the pharmacy benefit. If the vaccine is administered at a doctor’s office or another clinical site of care, it will be covered under the medical benefit. 

Will Anthem waive cost shares on treatments for potential complications from a COVID-19 vaccine? 

No, Anthem will not waive cost shares on treatments for potential complications from a COVID-19 vaccine.

Which retail pharmacies will have access to the vaccines?

Below is a list of retail pharmacies that have partnered with HHS on Nov. 6 to provide access to vaccines when they become available. The list includes pharmacies across the nation, with approximately 60 percent of all US pharmacies to date. 

· Albertsons Companies, Inc. (Osco, Jewel-Osco, Albertsons, Albertsons Market, Safeway, Tom Thumb, Star Market, Shaws, Haggen, Acme, Randalls, Carrs, Market Street, United, Vons, Pavilions, Amigos, Lucky’s, Pak n Save, Sav-On)

· Costco Wholesale Corp.

· CPESN USA, LLC

· CVS Pharmacy, Inc. (Long’s)

· Good Neighbor Pharmacy and AmerisourceBergen Drug Corporation’s PSAO, Elevate Provider · Health Mart Systems, Inc. · H-E-B, LP · Hy-Vee, Inc.

· LeaderNET and Medicine Shoppe, Cardinal Health’s PSAOs · Managed Health Care Associates (MHA) · Meijer Inc.

· Publix Super Markets, Inc.

· Retail Business Services, LLC (Food Lion, Giant Food, The Giant Company, Hannaford Bros Co, Stop & Shop) · Rite Aid Corp.

· The Kroger Co. (Kroger, Harris Teeter, Fred Meyer, Frys, Ralphs, King Soopers, Smiths, City Market, Dillons, Marianos, Pick-n-Save, Copps, Metro Market)

· Topco Associates, LLC (Big-Y Pharmacy and Wellness Center, Brookshire’s Pharmacy, Super One Pharmacy, FRESH by Brookshire’s Pharmacy, Coborn’s Pharmacy, Cash Wise Pharmacy, MarketPlace Pharmacy, Hartig Drug Company, King Kullen, Food City Pharmacy, Ingles Pharmacy, Raley’s, Bel Air, Nob Hill Pharmacies, Save Mart Pharmacies, Lucky Pharmacies, SpartanNash, Price Chopper, Market 32, Tops Friendly Markets, ShopRite, Wegmans, Weis Markets, Acme Fresh Markets)

· Walgreens (Duane Reade)

· Walmart, Inc. (Sam’s Club)

· Winn-Dixie Stores Inc. (Winn-Dixie, Harveys, Fresco Y Mas)

Will the federal government be paying for the cost of the COVID-19 vaccines and their administration?

At least in the short term, the cost of the vaccines, and ancillary supplies will be funded by HHS. The CDC has indicated the vaccine purchased with US taxpayers’ dollars will be available at no cost. 

CMS, along with the Departments of Labor and the Treasury, require that fully-insured and self-funded plans cover the vaccine and vaccine administration with no member cost-sharing for the duration of the public health emergency.

HHS does not cover the costs of vaccine administration for commercial or Medicaid members but they will cover administration for Medicare beneficiaries, including Medicare Advantage members. Anthem health plans will cover those costs for fully-insured, employer-sponsored customers and many Medicaid members unless otherwise directed by a state. Self-insured customers will be financially responsible for the administration fees.

CMS has announced the fees to administer the vaccines at pharmacies range from $16.94 for the first dose, covid-faqs8.39 for the second dose and covid-faqs8.39 for vaccines requiring one dose only.

How is Anthem reimbursing providers for FDA-Approved COVID-19 Vaccines?

The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. Anthem will reimburse for the administration of COVID-19 FDA-approved vaccines in accordance with Federal and State mandates. 

 

6.94 for the first dose, covid-faqs8.39 for the second dose and covid-faqs8.39 for vaccines requiring one dose only.

How is Anthem reimbursing providers for FDA-Approved COVID-19 Vaccines?

The cost of COVID-19 FDA-approved vaccines will initially be paid for by the government. Anthem will reimburse for the administration of COVID-19 FDA-approved vaccines in accordance with Federal and State mandates.