David Pope, PharmD, CDE, Chief Innovation Officer
In the coming weeks and months, the highly anticipated COVID-19 vaccine will be delivered to providers across the country. The CDC recently created a playbook that provides guidance on distribution, initial recipients, documentation and data sharing.
As a pharmacist, you play a vital role in vaccinating Americans. I have been engaged with the CDC on a weekly basis to work through how pharmacy can mobilize to distribute and administer a COVID-19 vaccine once available. New information is revealed each week, so stay tuned for updates. In the meantime, here’s the latest on what the CDC has outlined to date.
A phased approach
In Phase 1a, healthcare personnel, including pharmacists, should personally receive the vaccine. Shortly thereafter in Phase 1b, essential workers, patients with high-risk medical conditions and adults 65 years or older will be eligible for the vaccine (adults 65 years and older represent 16% of COVID-19 cases, but result in nearly 80% of COVID-19 deaths).
It’s likely the initial vaccine will be delivered directly to hospitals and long-term care (LTC) facilities. Pharmacies serving LTC facilities may begin to receive the vaccine early in the phased process. Phases 2 and 3 represent the ability to vaccinate the general public, with a priority focus on high-risk populations. It’s expected pharmacies will play a central role in vaccinating the public in Phases 2 and 3.
Understanding the new requirements
Due to the shortened nature of the vaccine production process, the federal government has defined additional data points that must be documented, as well as new requirements around administration of the vaccine:
- Patient immunization history must be reviewed prior to providing the dose.
- The same vaccine manufacturer must be used to provide the second dose.
- Vaccine administration must be posted to relevant authorities within 24 hours.
How to get paid
While the initial vaccine will be delivered at no cost to pharmacies, Medicare Part B and other payers will reimburse for the administration of the vaccine so it’s important to start considering how you will bill for administration.
Thankfully, the Medicare billing pathway for COVID-19 vaccines largely mirrors the current approach pharmacies use today for flu shots. State Medicaid organizations and other commercial providers are finalizing their approaches, and OmniSYS will provide guidance as soon as these processes are defined.
It’s imperative you begin today to prepare to provide this vaccine.
- Verify your medical billing pathway. Align your organization with experts who are prepared to support this new billing pathway, and ensure you get quickly and accurately reimbursed for COVID-19 vaccine administration.
- Partner with a CDC-enrolled organization to receive the vaccine. This may be a PSAO, buying group or clinically-integrated network.
- Upgrade your technology if necessary. You need a solution that provides billing, documentation, immunization history and the ability to post completed vaccines to the proper authorities – all within workflow. Once the vaccine is generally available, the volume of patients seeking the vaccine at pharmacies will be high, and inefficient processes just won’t work.
The CDC has clearly and unequivocally said that pharmacists are essential to the success of administering a COVID-19 vaccine. We are all hopeful that a vaccine will be available soon, and the time to start preparing is now.
David Pope, PharmD, CDE Chief Innovation Officer
In his role as chief innovation officer, David Pope, PharmD, CDE, leads OmniSYS’s efforts to develop innovative solutions that support the evolving role of pharmacy in healthcare delivery. Dr. Pope is a nationally-recognized expert in medical informatics and clinical services in the pharmacy space, and has served as an advisor for the Center for Disease Control (CDC) as well as multiple Fortune 500 healthcare-related organizations.