12 Ways Pharmacy Benefit Managers Are Helping Patients Access COVID-19 Vaccines

We stand at a promising moment in the course of the COVID-19 pandemic. Vaccines are becoming more widely available as states are opening vaccination appointments to broader categories of a greater number of individuals. Mass vaccination sites are opening, pharmacies are working on the front lines to create even more vaccination locations, and America is beginning to see light at the end of the tunnel.

But as more information becomes available about COVID-19 vaccines, navigating it all can still be a challenge for those seeking their turn in line. Pharmacy benefit managers (PBMs) have substantial experience helping patients access prescription drugs. As patients and families have questions about where to get a vaccine, when to receive their shot, or even if they qualify, PBMs are taking action to support national, state, and local COVID-19 vaccination efforts.

Unfortunately, there has been some misinformation regarding vaccine access, implementation, and administrative billing. But the facts are clear: PBMs are working with the entire prescription drug and payer chain to create real time solutions to help Americans overcome COVID-19 and return to a more normal way of life.

Here are 12 ways PBMs are collaborating to help ensure a safe and effective vaccination effort against COVID-19:

  1. Working with employers and other plan sponsors to coordinate efforts to support access to COVID-19 vaccines at nearby pharmacies with no cost-sharing ($0 copay). In line with the Coronavirus Aid, Relief, and Economic Security (CARES) Act, PBMs are helping health plan sponsors to provide zero-cost access to COVID-19 vaccines when administered in a pharmacy setting during this national public health emergency. PBMs are supporting COVID-19 vaccines being billed through the pharmacy benefit for plan sponsors that elect that option and where permitted under federal and state regulations.
  2. Identifying people currently eligible to receive the vaccine based on current state or county requirements.
  3. Conducting second-dose outreach programs to people who receive the first dose of either the Pfizer or Moderna COVID-19 vaccines. For example, PBMs are calling people who obtained their first dose at a nearby pharmacy and have missed their second dose.
  4. Ensuring people vaccinated for COVID-19 have digital access to their vaccination record by advancing a cross-industry standard COVID-19 vaccine credential in an accessible, interoperable, digital format.
  5. Helping patients navigate vaccine resources, including by making it easier to understand the different vaccine eligibility guidelines; explaining what to expect when you’re eligible to receive the vaccine, requirements by state and county, and whether the vaccines are covered under their pharmacy benefits plan; and finding local COVID-19 vaccine resources, plus participating pharmacies.
  6. Answering patients’ questions about the safety, efficacy, and side effects of authorized COVID-19 vaccines, including through national awareness campaigns and local community efforts to promote vaccine uptake, explaining the benefits of vaccines, and providing credible information and answers to common questions (like web videos and FAQs).
  7. Reviewing the latest information regarding authorized and in-development COVID-19 vaccines to support plan sponsor understanding and coverage, particularly in cases where a particular vaccine is recommended for certain populations.
  8. Surveying communities to understand vaccine hesitancy and related concerns to best support patient awareness and promote vaccination.
  9. Supporting the monitoring and reporting of vaccine-related adverse events.
  10. Helping people erroneously charged for the vaccine or its administration to get their money back.
  11. Alerting patients and providers of COVID-19 vaccine fraud schemes.
  12. Collaborating across the pharmaceutical supply and payment chain to trouble-shoot patient access issues in real time working with pharmacies to address common billing errors and sharing recommendations with the Centers for Medicare & Medicaid Services to ensure Medicare beneficiaries aren’t turned away for bringing their Medicare Advantage insurance card rather than their Original Medicare card. PBMs know the importance of pharmacies remaining focused on providing patient care.

The PBM industry is committed to ensuring the greatest number of patients are vaccinated as efficiently as possible. We are making tremendous strides in the fight against COVID-19 and are partnering with others to make this a reality so we can move forward together as a nation.

JC Scott is the President & CEO of the Pharmaceutical Care Management Association (PCMA), the association representing America’s pharmacy benefit managers