Updated Medicaid Reimbursement for Vaccines and Contraceptives May Come This Summer

Primary care physicians and obstetricians-gynecologists received some promising news recently. The NC Department of Health and Human Services (NCDHHS) has begun the process to increase reimbursement for physician-administered vaccines and contraceptives in Medicaid’s Physician Drug Program. We applaud NCDHHS for taking action on this long-standing issue and congratulate the specialties affected by this proposed change. The North Carolina Medical Society (NCMS) will continue to advocate for fee updates in the Physician Drug Program,  including for drugs ordered regularly by oncologists and rheumatologists.

In a posted State Plan Amendment last week, NCDHHS is proposing to revise the reimbursement rate for physician-administered vaccines to wholesale acquisition cost (WAC) plus 3 percent, and the rate for physician-administered contraceptives to WAC plus 6 percent. The posting on May 10 triggers the 10-day notice and comment period required before submitting the amendment request to the Centers for Medicare and Medicaid Services (CMS). If the process goes smoothly and CMS approves the change, the new payment formula will take effect July 1, 2017.

As some drug and device costs have increased, physicians providing those services to Medicaid patients have been requesting an update to the fee formula in order to cover their costs for purchase of the vaccines and contraceptives.



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  • Jane Simmons

    Since we don’t pay for Medicaid vaccines, is this referencing the private vaccines for Health Choice?

    • Elaine Ellis

      Yes, if approved, we understand that the reimbursement change will apply to vaccines currently reimbursable through the Physician Drug Program; i.e., the vaccines that the practice acquires from a private source and not through the Vaccines for Children program.