Has Medicare recently increased its payment rate for the pneumococcal vaccine?
On Oct. 1, Medicare began paying $18.62 for the pneumococcal vaccine, a figure that is significantly higher than last year’s reimbursement of $13.10. The change reflects ACP’s efforts to alert the Centers for Medicare and Medicaid Services (CMS) that its methodology for determining the payment rate was inaccurate. The agency had been calculating a price for the pneumococcal vaccine based on the cost of a product that is no longer on the market and a price that was available to only a limited number of purchasers. This calculation flaw resulted in a Medicare payment that was substantially below physicians’ cost to actually purchase the vaccine. Q: When did the CMS announce the pneumococcal vaccine payment increase? A: The CMS announced in August that it would raise the Medicare payment for the pneumococcal vaccine. While the CMS normally announces payment changes shortly before or after they are implemented, the agency agreed with ACP and other physician organizations that it was import
