24-955m Changes to Pharmacy Administration Reimbursement for ACIP-Recommended Vaccines
Date: 09/17/24
As of August 1, 2024, pharmacy administration will be paid under Medi-Cal Rx or pharmacies can bill Health Net* under the member’s medical benefit
The Department of Health Care Services issued All Plan Letter (APL) 24-008 (PDF) on June 21, 2024, to clarify requirements recommended by the Advisory Committee on Immunization Practices (ACIP) to immunization services, including reimbursement to pharmacists for vaccine administration, starting August 1, 2024.
Vaccine coverage
Health Net and its delegated participating physician groups (PPGs) must cover all approved adult vaccines recommended by the ACIP without member cost-share. These vaccines are available at no cost for children under 19 through the Vaccines for Children (VFC) program. These vaccines must be offered timely and without prior authorization requirements to children and adults according to the latest ACIP immunization schedule.
More information about medication coverage is available in the Prescription Drug Program section of the Medi-Cal Provider Operations Manual.
Pharmacy administration reimbursement
Pharmacists are authorized to administer vaccines to members under the criteria detailed in the California Business and Professions Code (B&P) section 4052(a)(11)1 and are reimbursed as follows:
- As of August 1, 2024, retroactive to January 1, 2023, reimbursement for pharmacy administration of VFC-funded vaccines is new and will be paid for members under Medi-Cal Rx using National Council for Prescription Drug Program standards.
- Starting August 1, 2024, retroactive to January 1, 2023, pharmacies have the option of submitting a medical claim to Health Net or the delegated PPG for the vaccine administration fee in lieu of submitting a pharmacy claim to Medi-Cal Rx for this fee.
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone 800-675-6110 or through the Health Net provider portal.
To access APL 24-008 (PDF).
1The B&P can be searched at California Legislative Information website.
This information applies to Physicians and Participating Physician Groups (PPGs).
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.