RSV Vaccination Coverage and Processing
The Food and Drug Administration along with the Centers for Disease Control recently approved vaccines for RSV (respiratory syncytial virus), a common respiratory virus that can cause severe impacts to infants and older adults. As required by the Affordable Care Act, the NRECA Medical Plan will cover RSV vaccines at 100% for the following groups:
- Individuals age 60 and older
- Pregnant women
- Children age five and under
Vaccines for pregnant women and children (age five and under) can be administered only in a physician’s office. Individuals age 60 and older may have vaccines administered at a pharmacy or physician’s office.
Due to a system update with the plan’s pharmacy benefit manager, CVS Caremark®, vaccines administered in a pharmacy setting through the end of October will result in a bill to the patient. Once this system update is completed at the end of the month, all RSV vaccines administered to eligible individuals will be directly charged and patients will not be responsible for cost share.
Individuals who receive a bill in a pharmacy setting for the RSV vaccine are eligible for reimbursement from the plan. Individuals receiving an RSV vaccine in a physician’s office during this time will have charges submitted directly to the plan.
Individuals seeking reimbursement for RSV vaccine charges should reach out to CVS Caremark at 888.796.7322 or caremark.com for information on how to submit their receipts for reimbursement.
An educational article on the RSV vaccine highlighting its coverage under the NRECA Medical Plan will appear in the upcoming issue of Energize. Individuals should speak with a medical professional if they have questions about whether they should receive the vaccine.