Prime Therapeutics Boosts COVID-19 Vax Administration Fees To Match What CMS Is Paying

Prime Therapeutics is following CMS’s lead and raising fees it pays pharmacies for administering the COVID-19 vaccines.

Prime, a PBM owned by 19 Blues plans, is matching the fee increases that CMS recently announced, so it will pay pharmacies $40 for administering a single dose vaccine, a 41% increase from the previous fee of $28.39, and $80 for a two-dose vaccine, a 76% increase over the previous fee of $45.33.

The boost in fees applies to people covered by commercial and ACA marketplace plans sold by the 23 Blues plans that Prime has as clients. Medicaid administration fees are determined by each state, and Prime said in a press release that it will adjust its Medicaid reimbursement rates according to guidance it receives from its Blue Plan clients.

Also, the fee that Prime pays only covers the cost of administration of the vaccine and does not include the cost of the COVID-19 vaccine itself. So far, the federal government is shouldering the cost of the COVID-19 vaccines through contracts with Pfizer, Moderna and Johnson & Johnson, the manufacturers of the three vaccines that have received emergency use authorizations from the FDA.

David Lassen

David Lassen, Prime’s chief clinical officer, said in an interview with MHE that the company was increasing the fee because “it is the right thing to do” and vaccination was the country’s number one priority right now. Lassen also mentioned “alignment” and that an administration fee that matches Medicare rates simplifies matters “so we call pull that (the price) across our lines of business.”

Prime, which is headquartered in the suburban Twin Cities, manages the pharmacy benefits of 33 million people. Prime had paid pharmacies a total of $29 million in COVID-19 vaccine administration fees through March 25, an amount that covered 1,238,636 claims, according to figures from the company.

Lassen noted that Prime’s administration fees apply to vaccines administered under the pharmacy benefit managed by Prime. The administration fee of people who get vaccinated at a medical facility might be paid under the medical benefit and would be outside Prime’s purview, he explained.