Facing a vaccine price increase….what can you do?

Price increases in general are not fun.  Fortunately in the case of vaccines, buying group members receive 30 to 90 days of advanced notice before the new pricing becomes effective.  This timing enables a practice to take action to minimize the negative impact to their bottom line.  Here are several steps you can take:

  • Notify your payers of the change and refer them to the updated CDC Private Sector List price as the benchmark for reimbursements.
  • Update your billing rates accordingly
  • Purchase a refrigerator and freezer large enough to store extra vaccines purchased during this discount period
  • Strategically time your purchases so that you can purchase as much product as you can at the pre-increase price
  • Check all invoices to make sure the pre-increase price is honored through the implementation date

If you have any questions about the overall financial health of your immunization services, contact CPP for a free analysis!

AAP advocacy leads to change in coding for vaccine administration.

Medically unlikely edits (MUEs) are the daily limit placed by the Centers for Medicare & Medicaid Services (CMS) on billed CPT codes and are often used by private payers to reduce the likelihood of coding errors. With the assistance of the Section on Administration and Practice Management (SOAPM) and the Committee on Coding and Nomenclature (COCN), the Academy worked with CMS to update the MUEs associated with the vaccine administration codes 90460 and 90461 based on clinical rationale.

The updates are as follows:

  • Effective April 1, 2017, the MUE for 90460 will go from 6 to 9
  • Effective July 1, 2016, the MUE for 90461 will go from 5 to 8                                          (Since this update was published January 1, 2017 but was effective July 1, 2016, any denials since this date should be appealed.)

If you receive denials for MUEs, email the AAP coding hotline at aapcodinghotline@aap.org.  (Full Article)

Zostavax Price Increase

Merck has announced a price increase to Zostavax effective January 6, 2017.  The new pricing will become effective for CPP members on April 6, 2017.  For updated pricing sheets, please contact the CPP office at cpp@nationwidechildrens.org or 614-722-2145.

Quadracel™ now available for purchase!

Sanofi Pasteur is now accepting orders for Quadracel™ (Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed and Inactivated Poliovirus Vaccine).  Doses are available in a 10-dose package, vial presentation (NDC# 49281-562-10; see full product information).

Orders can be placed now by going to http://www.VaccineShoppe.com and are expected to ship in February 2017.

2017-2018 Flu Season Vaccine Announcement

The Sanofi Pasteur Fluzone® Partner pricing and terms for the upcoming 2017-2018 flu season have been announced and sent to our membership.  If you are a CPP member and did not receive the details, please contact us.

The pre-book period is now open and you can make your flu reservation at any time by going to http://www.VaccineShoppe.com.   Reservations must be confirmed by March 31, 2017.

If you have any questions or need additional information, please don’t hesitate to contact the CPP office at 614-722-2145 or your Sanofi Pasteur representative.