Important Changes to COVID Vaccine Administration Fee for Pharmacies

Nov 03, 2023

In the coming weeks, MaineCare will update the administration fee for the 2023-2024 commercial COVID-19 vaccines to $39.11, to align with Medicare reimbursements. This change will be retroactive to September 11, 2023.  

Pharmacies may be reimbursed for injectable COVID-19 vaccinations administered to MaineCare members who are 19 years and older. Pharmacists must be enrolled in MaineCare, certified to administer vaccines in the State of Maine, and be compliant with all Maine laws governing vaccine administration. Failure to comply with all Maine immunization regulations will subject these claims to recoupment.      

Currently covered COVID-19 vaccines:   

• Comirnaty® (Pfizer) 

• Novavax® 

• Spikevax® (Moderna)   

Pharmacies are reimbursed for the ingredient cost plus administration OR dispensing fee for COVID-19 vaccines. Basis of Cost and Submission Clarification Codes are no longer required.     

Through the pharmacy Point of Sale (POS) system, the pharmacy must submit the code “MA” in the Professional Service Code field for the COVID-19 vaccine claim to document the administration of the vaccine and receive full administration fee reimbursement.  

There is NO member copay for vaccines. COVID-19 vaccines and their administration must be provided without cost sharing as required by the American Rescue Plan Act (ARPA) of 2021. The ARPA requirement applies only to those persons with current MaineCare coverage. Anyone who is uninsured or who does not have full MaineCare coverage may have access to the vaccine through the Centers for Disease Control (CDC) Bridge Access Program.  

  

Required NCPDP Fields
NCPDP Field Number	NCPDP Field Description	Required Code
44Ø-E5	Professional Service Code	MA
4Ø7-D7	Product/Service ID	NDC for vaccine

  

For questions, please contact the Change Healthcare Pharmacy Help Desk at 1-888-420-9711. Maine providers can also send inquiries via email to PBA_helpdesk@changehealthcare.com.     

Additionally, The Maine Center for Disease Control and Prevention (CDC) reports that < 2% of Maine children 18 and younger are vaccinated with the updated COVID-19 formulation. MaineCare encourages pharmacies to enroll in the Vaccine for Children’s program to obtain COVID-19 and seasonal influenza vaccines at no cost by contacting the Maine Immunization Program at ImmunizeMe.dhhs@maine.gov.