Additional Doses, Booster Doses – Basic Procedures Announced but More to be Determined

Sep 01, 2021

AmerisourceBergen continues to advocate at state and federal levels for fair and adequate reimbursement and procedural policies to ensure the rollouts of additional and booster COVID-19 vaccines proceed smoothly and successfully for pharmacists, physicians and patients.

U.S. Public Health Agencies Announce Procedures for an Additional COVID-19 Vaccination Dose for Certain Immunocompromised Individuals and Recommend the General Public Receive a COVID-19 Booster Dose 8 Months After Completion of Initial Regime.

Emergency Use Authorization Amended to Allow for an Additional COVID-19 Vaccination Dose for Certain Immunocompromised Individuals

The FDA recently amended the emergency use authorizations (EUA) for both the Pfizer-BioNTech and Moderna COVID-19 vaccines to allow for administration of an additional dose for moderately to severely immunocompromised individuals previously vaccinated with these mRNA vaccines. Qualifying individuals whose original company’s vaccine is not available can receive the additional dose from the “other” company (“mix or match” or “interchangeability”). Medicare reimbursement will mirror the current approximately $40 per dose payment. At this time, the EUA for the JNJ-Janssen COVID-19 vaccine has not been amended for an additional dose.

For billing and reimbursement details during the PHE (Public Health Emergency), see the following NCPA resource: COVID-19_vaccine_billing_for_NCPA_Members.pdf (which NCPA has made publicly available to non-members).

U.S. Public Health Agencies Recommend the General Public Receive a COVID-19 Booster Dose 8 months after Completion of Initial Regimen

On August 18, HHS public health and medical experts announced the Biden Administration’s plan to make widely available COVID-19 booster shots beginning September 20, with immunizations to begin 8 months after the administration of an individual’s Pfizer-BioNTech or Moderna 2nd dose, and the intention to make a follow-up JNJ-Janssen booster dose available in the future.

Many questions remain, including ones regarding effective COVID-19 vaccine uptake and administration in conjunction with flu shots; self-attestation capabilities; whether interchangeability will also apply to the booster doses; procedure and payment alignment in federal and commercial payor programs; and procedures in 2022 (and beyond).