The FDA has granted an Emergency Use Authorization (EUA) to Pfizer's COVID-19 vaccine in the United States! As this vaccine begins rolling out to administration sites and the FDA considers an EUA for other COVID-19 vaccine candidates, you may have questions about your coverage for the vaccine.
Here’s what we know about vaccination against COVID-19:
You will be charged $0 for the vaccine at an in-network provider.
Texas has a statewide plan for allocating available doses to each local area, and will make it available to certain high-priority groups first.
Where can I get the vaccine?
Is TML Health paying for the vaccine or is it free?
Your healthcare provider, such as a pharmacy, can charge a fee to administer the vaccine, but our Pharmacy Benefit Manager, Navitus, has negotiated a rate it will pay to in-network pharmacies. You will not pay this amount; your pharmacy benefit will pay.
During the public health emergency, coverage for the vaccine will be provided without cost sharing to the member
If vaccine availability is limited, how will I prove my membership in a priority group, like first responders?
The pharmacies themselves, not TML Health or Navitus, will determine who qualifies to get the vaccine because of their membership in a priority group.
Can my employer require me to be vaccinated to return to work?
New guidance from the Equal Employment Opportunity Commission allows employers to require workers to get COVID-19 vaccinations. Currently the COVID-19 vaccines are approved by the FDA under Emergency Use Authorization (EUA), and supply of the vaccine is limited. You can find more information about the Americans with Disabilities Act, Rehabilitation Act, the Pregnancy Discrimination Act, and other legislation as it relates to the vaccine here. https://www.insurancejournal.com/news/national/2020/12/16/594252.htm
Someone I know has no health insurance. Can they get the vaccine for free?
Yes! The healthcare provider who administers the vaccine to an uninsured person should bill the U.S. Health Resources and Services Administration, not the patient.