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Medicare Covers COVID-19 Booster for Immunocompromised Americans
The coronavirus booster shot will be cost-free for immunocompromised Americans as the Delta variant sweeps across the globe.
CMS has announced that immunocompromised individuals will receive the coronavirus booster shot without cost-sharing.
On August 12, 2021, the Food and Drug Administration (FDA) recommended a booster shot of the coronavirus vaccine for all Americans who are immunocompromised.
Individuals who are immunocompromised have a debilitated immune system and are especially susceptible to the coronavirus. This may be as a result of chronic diseases like lupus or Type 1 diabetes, medical treatments such as chemotherapy, organ or bone marrow transplants, aging, or smoking habits.
CMS announced that Medicare would cover the administration costs for the coronavirus vaccine booster shots. Medicare will reimburse providers for the booster shot at the same rate that they reimburse for any other coronavirus vaccine dose. The national average payment rate for immunization administrators is $40 per coronavirus vaccine dose.
The agency promised to share more information about billing and coding for booster shots in the near future.
The Delta variant of the coronavirus started sweeping across the world at the same time that vaccine uptake in the US began to plateau. In response, experts, government officials, and private companies took steps to increase coronavirus vaccination and began to explore booster shots for the already-vaccinated.
“The country has entered yet another wave of the COVID-19 pandemic, and the FDA is especially cognizant that immunocompromised people are particularly at risk for severe disease. After a thorough review of the available data, the FDA determined that this small, vulnerable group may benefit from a third dose of the Pfizer-BioNTech or Moderna Vaccines,” acting FDA Commissioner Janet Woodcock, MD, said in the FDA announcement.
“Today’s action allows doctors to boost immunity in certain immunocompromised individuals who need extra protection from COVID-19. As we’ve previously stated, other individuals who are fully vaccinated are adequately protected and do not need an additional dose of COVID-19 vaccine at this time. The FDA is actively engaged in a science-based, rigorous process with our federal partners to consider whether an additional dose may be needed in the future.”
As the nation grapples with the implications of the Delta variant, many payers are redoubling their efforts to diminish vaccination racial care disparities and to improve outreach to vulnerable communities.
