Medicare coronavirus paid by the government predicted by the end of the month, Verma said: HLTH 2020

• CMS is almost ready to post a rule guaranteeing Medicare recipients free access to all coronavirus vaccines, agency director Seema Verma said at the HLTH virtual conference Tuesday.

• “I think you’ll see the rest of the agency in talks by the end of the month,” said Verma. “Obviously Congress wants to make sure Medicare beneficiaries and vaccines don’t have to share money, so stay tuned.”

• It typically takes CMS one to three years to resolve payment issues for new treatments or vaccines, Verma said. It is unknown if CMS has the regulator to reimburse a vaccine if the FDA approves it with an emergency clearance, as health officials are hoping.

Part B, which covers immunizations for Medicare beneficiaries, does not cover immunizations approved under the EEA. Therefore, CMS as such is required by law to ensure that beneficiaries in Medicare have access to the approved coronavirus vaccine in the fastest way.

CMS worked with Operation Warp Speed on a vaccine payment strategy while ensuring that vendors were reimbursed for administrative costs and that commercial payers didn’t hinder wider access, Verma said.

With Medicare, the federal government must cover the cost of the vaccine for those with commercial insurance. Coronavirus Aid, Aid, and the Economic Security Act passed by Congress in March made the vaccine a “preventable health service,” which means the plan will pay for its members without implementing any spending.

CARES also states that Medicare beneficiaries will not be able to share the cost of a vaccine once it becomes available.

However, determining how much the administration will reimburse vaccines in Medicare is an ongoing process as goals change with the pioneers of the vaccine race. For example, there may be additional costs for storing a coronavirus vaccine at a low temperature or because some of the candidates require two doses, experts say.

On Monday, pharmaceutical company Johnson & Johnson announced that it would suspend clinical trials of its vaccine candidate due to illness in a study participant. This is the second Phase 3 coronavirus vaccine study to be canceled for safety clearance in the US after the US trial with AstraZeneca was discontinued last month.

Many experts believe that COVID-19 vaccines will be available for the first time in the US during the public health emergency, although stricter guidelines from the FDA make it unlikely a vaccine will be approved before the November elections.

Verma also joked Tuesday that the agency was considering ways to get providers to take more risk in their value-based payment models, building on the COVID-19 waivers previously published by the agency. Some of these flexibilities could be translated into value-based CMS models to encourage supplier involvement and encourage them to take more risks.

“I think in the future we can look at the types of exemptions we are making [during the pandemic] and potentially use them as incentives for some of our value-based models,” Verma said. “Because I think the way they were created before was just to encourage participation, which didn’t necessarily translate into lower costs.”