Since COVID-19 vaccines became widely available, it has been relatively easy for providers to access vaccines for their patients. Over the past two years, the federal government has used emergency funds to purchase vaccines and distribute doses to providers at no cost. However, this won’t be the case for much longer, as significant changes to vaccine manufacturing, procurement, and pricing are expected as a result of depleted funds and the end of the public health emergency.
When the federally purchased supply of vaccines runs out or becomes superseded by a new variant booster—likely by fall 2023—COVID-19 vaccines will transition to the commercial market. With commercialization, the onus will be on providers, practices, and payers to play a greater role in COVID-19 vaccine access and coverage. Below, we highlight three considerations for providers prior to offering the vaccine in their practice.
Payer Reimbursement
The initial agreement to make vaccines freely available to all consumers, regardless of insurance coverage, will be void when COVID-19 vaccines enter the private market. In order to protect free access for the insured and keep costs low for the uninsured, providers need to coordinate with their key payers to ensure there’s sufficient coverage. Per the vaccine manufacturers, the expected cost for these vaccines in the private sector will be between $110 and $130 per dose. It’s critical for providers to confirm how much health plans will reimburse and be confident that they’ll reimburse appropriately.
Storage Requirements
Proper vaccine storage and handling practices play an important role in protecting the public. Maintaining the quality of vaccines is a shared responsibility of all parties involved, from the time a vaccine is manufactured until it is administered. One of the complexities of the COVID-19 vaccine is the management of cold chain logistics, including refrigeration at healthcare facilities.
Adequate on-site refrigerated storage is necessary, especially as new COVID-19 vaccines are released. For instance, the US Food and Drug Administration recently recommended that vaccine manufacturers produce new single-strain booster shots by this fall to target the Omicron subvariant XBB.1.5. To prepare for upcoming changes, providers should review available resources on proper vaccine storage and handling to ensure they meet the requirements.
Patient Population
Before taking on the financial and operational challenges of offering the COVID-19 vaccine in their practice, providers should consider if there is a high demand for the current and future versions of the vaccine among their patient population. While it’s important to provide the public with easy access to vaccines, there’s a risk of wasting COVID-19 vaccine doses if patients do not request or require vaccination. If a majority of a provider’s patients are not eligible for the COVID-19 vaccine, perhaps because of their age or the nature of their healthcare condition, it might not be worth the effort to offer the vaccine once it’s commercialized. For example, almost half of parents of children under age five have said they will “definitely not” get their child vaccinated for COVID-19.
As the nation’s leading Physician Buying Group, Atlantic Health Partners anticipates being able to offer members favorable pricing for all available COVID-19 vaccines, including Pfizer and Moderna, and will review any future vaccines introduced to the market. We're committed to helping members navigate the imminent COVID-19 vaccine commercialization and successfully incorporate these vaccines into their immunization programs.
Learn more about working with Atlantic and find additional vaccine resources on our website.