How PBMs are Helping Patients Access COVID-19 Vaccines

As more information becomes available about when Americans become eligible to receive a COVID-19 vaccine, based on priorities set by states, navigating it all can be a challenge. PBMs have substantial experience helping patients get the prescription drugs and the vaccines they need, especially in times of crisis. As individuals and families have questions about where to get a vaccine, when to receive their shot, and even if they meet states’ eligibility priorities, PBMs are taking action to support national, state, and local COVID-19 vaccination efforts, including by:

  • Working with employers and other plan sponsors to coordinate efforts to support access to COVID-19 vaccines at nearby pharmacies with no cost-sharing ($0 copay). In line with the Coronavirus Aid, Relief, and Economic Security (CARES) Act, PBMs are helping health plan sponsors to provide zero-cost access to COVID-19 vaccines when administered in a pharmacy setting during this national public health emergency. PBMs are supporting COVID-19 vaccines being billed through the pharmacy benefit for plan sponsors that elect that option and where permitted under federal and state regulations.

  • Identifying people currently eligible to receive the vaccine based on current state or county requirements.

  • Conducting second-dose outreach programs to people who receive the first dose of either the Pfizer or Moderna COVID-19 vaccines. For example, PBMs are calling people who obtained their first dose at a nearby pharmacy and have missed their second dose.

  • Ensuring people vaccinated for COVID-19 have digital access to their vaccination record by advancing a cross-industry standard COVID-19 vaccine credential in an accessible, interoperable, digital format.

  • Helping patients navigate vaccine resources, including by making it easier to understand the different vaccine eligibility guidelines; explaining what to expect when you’re eligible to receive the vaccine, requirements by state and county, and whether the vaccines are covered under their pharmacy benefits plan; and finding local COVID-19 vaccine resources, plus participating pharmacies.

  • Answering patients’ questions about the safety, efficacy, and side effects of authorized COVID-19 vaccines, including through national awareness campaigns and local community efforts to promote vaccine uptake, explaining the benefits of vaccines, and providing credible information and answers to common questions (like web videos and FAQs).

  • Reviewing the latest information regarding authorized and in-development COVID-19 vaccines to support plan sponsor understanding and coverage, particularly in cases where a particular vaccine is recommended for certain populations.

  • Surveying communities to understand vaccine hesitancy and related concerns to best support patient awareness and promote vaccination.

  • Supporting the monitoring and reporting of vaccine-related adverse events.

  • Helping people erroneously charged for the vaccine or its administration to get their money back.

  • Alerting patients and providers of COVID-19 vaccine fraud schemes.

  • Collaborating across the pharmaceutical supply and payment chain to trouble-shoot patient access issues in real time, including working with pharmacies to address common billing errors and sharing recommendations with the Centers for Medicare & Medicaid Services to ensure Medicare beneficiaries aren’t turned away for bringing their Medicare Advantage insurance card rather than their Original Medicare card.

How can I learn more about the safety of COVID-19 vaccines?

The PBM industry is a proud partner of the COVID-19 Vaccine Education and Equity Project, which has developed a range of helpful resources explaining a range of vaccine questions, including on safety and availability.

Click on the logos below to find a sample of what individual companies are currently doing to support access to COVID-19 vaccines.

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