Home Forums Discussions General Discussion PCV13, Prevnar in medicare pts

Has anyone received reimbursement for Prevnar from Medicare?.
I have started administering it since early Jan. It was costly to purchase $150-200/dose depending on quantity requested.

We just received this memo:


FYI?update from Medicare regarding the Pneumo vaccine.
MLN Matters Number: MM9051

The Centers for Medicare & Medicaid Services (CMS) is updating the Medicare coverage requirements to align with the updated ACIP recommendations. Effective for dates of service on or after September 19, 2014, (and upon implementation of CR9051), Medicare will cover:

An initial pneumococcal vaccine to all Medicare beneficiaries who have never received the vaccine under Medicare Part B; and

A different, second pneumococcal vaccine one year after the first vaccine was administered (that is, 11 full months have passed following the month in which the last pneumococcal vaccine was administered).

Since the updated ACIP recommendations are specific to vaccine type and sequence of vaccination, prior pneumococcal vaccination history should be taken into consideration. For example, if a beneficiary who is 65 years or older received the 23-valent pneumococcal polysaccharide vaccine (PPSV23) a year or more ago, then the 13-valent pneumococcal conjugate vaccine (PCV13) should be administered next as the second in the series of the two recommended pneumococcal vaccinations. Receiving multiple vaccinations of the same vaccine type is not generally recommended. Ideally, providers should readily have access to vaccination history, such as with electronic health records, to ensure reasonable and necessary pneumococcal vaccinations.
Medicare does not require that a doctor of medicine or osteopathy order the vaccine; therefore, the beneficiary may receive the vaccine upon request without a physician?s order and without physician supervision.

Does that mean they can just go into the pharmacy to get it? Concerning stocking it, I question if Medicare will pay enough to even cover the cost of the vaccine. "Covered" and covered are two different words. I've seen them outright refuse to cover things listed in print as benefits for a wellness workup.

FYI: Got paid by Medicare for Prevnar. Pretty much covered my cost (which included a discount of $20 per dose for ordering 30 or more doses), when you include administration fee, which is what I hoped for. BCBS paid us just a little more for it.

Prevnar is getting reimbursed by all carriers including Medicare here in NM at about $153. cost to me is exactly that.
No profit in it for us but you do recoup your cost.