Required Health Plan Coverage for Pfizer-BioNTech COVID-19 Vaccine

This post was originally published by the Centers for Medicare and Medicaid Services.

On December 11, 2020, the U.S. Food and Drug Administration issued an Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine for the prevention of COVID-19 in individuals 16 years of age and older. Review Pfizer’s Fact Sheet for Healthcare Providers Administering Vaccine (Vaccination Providers) regarding the limitations of authorized use.

On December 12, 2020, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) issued an interim recommendation for use of the Pfizer-BioNTech COVID-19 vaccine for persons 16 years of age and older in the U.S. population under the FDA’s EUA. On December 13, 2020, the recommendation made by the ACIP was adopted by the CDC Director and published in the CDC’s Morbidity and Mortality Weekly Report.

Under the CARES Act and implementing interim final regulations, non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage must cover, without cost sharing, COVID-19 immunizations for which recommendations of the ACIP have been adopted by the Director of the CDC, starting 15 business days after the date an applicable recommendation is made by the ACIP.

Vaccines Information on the CDC Website

CDC has made available a wealth of information about the COVID-19 vaccine at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html . These resources may be useful for communicating with your enrollees. Specifically, you can access information about who gets vaccinated first, what to expect at the vaccine appointment, benefits of getting vaccinated, the safety of vaccines, and more.

For issuers who are integrated with health systems or communicating with your health systems, you can also check out the CDC’s COVID-19 Vaccination Communication Toolkit for medical centers, clinics and clinicians at: https://www.cdc.gov/vaccines/covid-19/health-systems-communication-toolkit.html. CDC is planning on publishing additional toolkits in the future.