22-072m Protect Your Pediatric Patients with Vaxelis and MenQuadfi Vaccines

Date: 01/28/22

This information applies to Participating Physician Groups (PPGs).

Understand and price these pediatric vaccines approved by the U.S. Food and Drug Administration (FDA)

Participating physician groups (PPGs) can use this update to address immunization-related issues for HMO and Point-of-Service (POS) members.

Financial responsibility

PPGs can identify financial responsibilities for Vaxelis and MenQuadfi in their Division of Financial Responsibility (DOFR) as follows:

• Vaxelis (CPT code 90697) -- Refer to the DOFR category of pediatric immunizations not subject to Health and Safety Code Section 1367.36
• MenQuadfi (CPT code 90619) -- Refer to the DOFR category of pediatric immunizations for meningococcal vaccines. If this category isn't outlined in the DOFR, then Health Net covers MenQuadfi in accordance with H&S Section 1367.36. Health Net and the PPG may agree to an alternative financial risk arrangement.

Price

Provider Participation Agreement (PPA) pricing exists for some immunizations subject to H&S Section 1367.36. For those without pricing in their Provider Participation Agreement (PPA), Health Net pays the lesser of the acquisition cost or the average wholesale price as defined in the Drug Topics Red Book. Health Net may audit vaccine claims for accuracy.

Vaxelis

Vaxelis is set to help pediatric patients prevent six diseases in a three-dose series.

Merck’s six-in-one vaccine - including antigens for diphtheria, tetanus toxoids, acellular pertussis, inactivated poliovirus, Haemophilus b conjugate and hepatitis B - is indicated for children ages 6 weeks to 4 years to prevent:

• Diphtheria
• Tetanus
• Pertussis
• Poliomyelitis
• Hepatitis B
• Invasive disease due to Haemophilus influenzae type b (Hib)

MenQuadfi

Sandofi’s MenQuadfi vaccine protects against invasive meningococcal disease caused by Neisseria meningitidis serogroups A, C, W and Y. MenQuadfi is available to individuals over age 2. It does not prevent N meningitidis serogroup B disease.

Additional information

If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center within 60 days, by phone or through the Health Net provider website.