Vermont Medicaid will reimburse pharmacies for the cost of the COVID-19 vaccine and its administration for children ages 3 to 19 outside of the Vaccines for Children Program (VFC). This is time-limited in accordance with the Public Readiness and Emergency Preparedness Act (PREP Act) requirements. The PREP Act authorizes pharmacists, pharmacy interns, and pharmacy technicians to administer COVID-19 vaccinations to children ages 3 and older. This change is retroactive to September 11, 2023.
COVID-19 vaccines and other routine children’s vaccines are currently available for Vermont Medicaid members under the age of 19 through the VFC Program. Pharmacies may submit claims retroactive to 9/11/23 for COVID-19 vaccines administered outside of the VFC Program. Members should work with the pharmacy for reimbursement if they paid out of pocket for a COVID-19 vaccine. There is NO member copay for vaccines. Other routine vaccines for children, including flu, must be obtained from a provider participating in the VCP Program.
Pharmacies may be reimbursed for injectable COVID-19 vaccinations administered to adults and children ages 3 and older who are enrolled in Medicaid. Pharmacists must be enrolled with Vermont Medicaid, certified to administer vaccines in the State of Vermont, and must be compliant with all PREP Act requirements governing vaccine administration.
Pharmacists, pharmacy interns, and pharmacy technicians must adhere to the requirements of the PREP Act for COVID-19 vaccine administration. The PREP Act declaration and guidance can be found on the U.S. Department of Health and Human Services website.
More information about the Vermont Immunization Program can be found on the Vermont Department of Health’s website.
Reimbursement for COVID-19 vaccines through the Medicaid medical benefit can be found on the Vermont Medicaid Fee Schedule and Vermont Medicaid General Billing and Forms Manual.
More information about vaccines for Medicaid enrolled pharmacies can be found in the Pharmacy Provider Manual.