Important updates regarding COVID-19 vaccine and testing policies

In response to the end of federal funding for COVID-19 flexibilities, effective September 30, 2024, the following changes apply to all Department of Medical Assistance Services (DMAS) fee-for-service (FFS) and all contracted managed care organizations. We are aligned with these policies.

Below is a summary of the key updates:

COVID-19 vaccines:

• The enhanced $40 vaccine administration fee for pharmacy providers will be discontinued. Moving forward, the vaccine administration fee will be reimbursed at our customary rate for all providers.
• We will continue reimbursing providers for all commercially available COVID-19 vaccines approved by the Advisory Committee on Immunization Practices (ACIP).

COVID-19 testing:

• Effective October 1, 2024, COVID-19 at-home, self-swab testing products are not reimbursable.
• Rapid COVID-19 tests and polymerase chain reaction (PCR) COVID-19 tests will continue to be covered for tests administered by providers, clinics, and federally qualified health centers. At‑home and pharmacy tests are not eligible.
• The federal government resumed offering up to four free at-home COVID-19 tests via COVIDtests.gov in late September 2024.

Lagevrio:

• Currently, Lagevrio is considered an investigational drug and has not received FDA approval.
• Without FDA approval, Lagevrio will not be covered under the Medicaid pharmacy or medical benefit.

The full notice provided by DMAS can be found here.

Thank you for your attention to these updates and for your ongoing commitment to providing exemplary care to our members. If you have any questions about this communication, call Provider Services at 800-901-0020.