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Second COVID-19 vaccine added to preventive care guidelines

Benefits Administration and Outsourcing|Health and Benefits|Total Rewards|Integrated Wellbeing
COVID 19 Coronavirus

By Maureen Gammon and Kathleen Rosenow | January 13, 2021

Non-grandfathered group health plans must begin to cover the Moderna COVID-19 vaccine with no cost sharing by January 12, 2021.

On December 18, 2020, the Food and Drug Administration (FDA) issued an Emergency Use Authorization for the Moderna COVID-19 vaccine. The following day, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention issued an interim recommendation for use of the Moderna COVID-19 vaccine in persons aged 18 years or older for the prevention of COVID-19.

Previously, on December 11, 2020, the Pfizer-BioNTech COVID-19 vaccine was authorized by the FDA and recommended by ACIP for use in persons aged 16 years or older for the prevention of COVID-19.1

In accordance with interim final regulations issued in October2 by the Departments of Labor, Health and Human Services, and Treasury, non-grandfathered group health plans must cover qualifying COVID-19 preventive services, including any vaccine and its administration, without cost sharing, within 15 business days of a recommendation from the United States Preventive Services Task Force (USPSTF) or the ACIP.

The ACIP’s recommendation started the 15-business-day period, meaning that non-grandfathered group health plans must begin to cover the Pfizer-BioNTech COVID-19 vaccine with no cost sharing by January 5, 2021, and the Moderna COVID-19 vaccine with no cost sharing by January 12, 2021.

Endnotes

1 See “COVID-19 vaccine added to preventive care guidelines,” Insider, December 2020.

2 See “Regulations on COVID-19 vaccine and testing requirements issued,” Insider, November 2020.

Authors

Senior Regulatory Advisor, Health and Benefits

Senior Regulatory Advisor, Health and Benefits

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