November 30, 2023

State of Alabama
Press Release: Medicaid

Coverage for Adult Vaccines/COVID Vaccines and Administration (Pharmacy Providers)

PDF Version


TO:  All Pharmacy Providers

 

RE:  Coverage for Adult Vaccines/COVID Vaccines and Administration (Pharmacy Providers)

 

Effective September 11, 2023, Alabama Medicaid will reimburse Medicaid-enrolled pharmacy providers for the administration and ingredient cost of the commercially distributed COVID vaccines. Effective October 1, 2023, Alabama Medicaid will reimburse Medicaid-enrolled pharmacy providers for the administration and ingredient cost of the Advisory Committee on Immunization Practices (ACIP) recommended vaccines for adults ages 19 and older. Claims may be retroactively billed to the effective date. Claims for a vaccine and the administration of the vaccine will be submitted on the same claim.

 

Instructions for submitting a pharmacy claim for a vaccine with the administration fee:

 

  • Pharmacies should submit a claim for the vaccine (i.e., ingredient) with the appropriate NDC.

 

  • Pharmacies should submit the administration fee in the Incentive Amount Submitted field

(NCPDP Field 438-E3) on the same claim as the vaccine (i.e., ingredient).

 

  • A maximum reimbursement of $5 is allowed for each vaccine administration (current exception of $40 administration for COVID vaccine). Only one dispensing fee (for the ingredient) and copay (if applicable) will be applied to the claim. Currently, copays are not applicable to any Medicaid pharmacy claim.

 


 

  • A prescription or standing order is required for each vaccine and administration to be retained on file for documentation purposes.

 

  • Claims for the administration fee only with no vaccine/ingredient will be denied. 

 

  • To facilitate coordination of care, Pharmacy providers are required to inform (via phone, fax, email, or mail) each recipient’s PMP upon administration of any vaccines for which an administration claim is submitted. Documentation must be kept on file at the pharmacy of the notification to the PMP. If the PMP is unknown, the pharmacy may call the Alabama Medicaid Automated Voice Response System (AVRS) at 1-800- 727-7848 to obtain the PMP information. Pharmacy providers may also notify the recipient’s local Alabama Coordinated Health Network (ACHN) region to assist with finding a PMP; ACHN contact information can be located on the Agency website under Contacts/ACHN Contacts. A suggested Immunization Provider Notification Letter, which can be used to notify the PMP, can be found on the Agency website under Pharmacy/Vaccines.

 

  • State and federal laws and regulations should be followed regarding the dispensing and administration of legend drugs/vaccines as well as products granted under Emergency Use Authorization (EUA).

 


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  • For more information, visit http://medicaid.alabama.gov
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