On Jan. 31, 2020, the Secretary of Health and Human Services declared the 2019 novel coronavirus (COVID-19) was a public-health emergency for the United States as of Jan. 27, 2020. In Dec. 2020, the Food and Drug Administration (FDA) began issuing Emergency Use Authorizations for COVID-19 vaccines. A list of COVID-19 products is available through the Formulary search (txvendordrug.com/formulary/formulary-search). Users can search by product name, the 11-digit NDC, or click the "COVID-19 vaccine" checkbox to review details about each vaccine.

Immunization Program Portal

The federal government distributes the COVID-19 vaccines. Pharmacies, retail clinics, providers, and other care sites receiving and administering the COVID-19 vaccine must complete the Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination Program Provider Agreement.

Providers should contact the Texas Department of State Health Services (DSHS) Immunization Program to register through the Texas DSHS Immunization Portal.

Claim Processing

HHSC set the fee-for-service (FFS) reimbursement rate to align with Medicare. For vaccines requiring a single or two doses, the FFS initial dose's administration reimbursement rate is $40.00. HHSC bases reimbursement on the submitted value in the "Incentive Amount Submitted" field (438-E3). The claim will pay $0 if the field is blank.

The Public Readiness and Emergency Preparedness Act allows certain providers to order and administer the COVID-19 vaccine, including pharmacists and pharmacy interns. To process a pharmacy vaccine administration claim, pharmacy staff should submit the following:

Pharmacies will receive a rejection for FFS claims when submitting a second dose claim if a client received their first dose from a non-Medicaid pharmacy. If your second dose claim is correct, the pharmacy can submit the following information to bypass the rejection: