Coverage of Commercialized COVID-19 Vaccines through Pharmacy Benefit

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HHSC now covers the following commercial COVID-19 vaccines as a pharmacy benefit in Medicaid and the Children’s Health Insurance Program (CHIP) that were recently approved by the Food and Drug Administration (FDA) for Emergency Use Authorization (EUA):

  • FDA approval Sept. 11, 2023:
    • 2023-2024 Pfizer-BioNTech COVID-19 Vaccine
    • 2023-2024 Moderna COVID-19 Vaccine
  • FDA approval Oct. 3, 2023:
    • 2023-2024 Novavax COVID-19 Vaccine

The new commercialized vaccines include a monovalent (single) component corresponding with the Omicron variant XBB.1.5. Unlike previous doses provided at no cost, commercialized COVID-19 vaccines are for purchase.
HHSC began covering the vaccines listed below for traditional fee-for-service Medicaid starting Nov. 20. Managed care organizations (MCOs) will begin coverage no later than Dec. 5.

HHSC backdated the effective date of formulary coverage to match the FDA approval dates below:

  • Sept. 11 for the Pfizer and Moderna vaccines
  • Oct. 3 for the Novavax vaccine.

The Submission Clarification Code field (420-DK) is no longer required when submitting COVID-19 vaccine claims.

NDCLabel Name
00069236201COMIRNATY 2023-24(12Y UP)
00069236210COMIRNATY 2023-24(12Y UP)
00069239201COMIRNATY 2023-24(12Y UP)
00069239210COMIRNATY 2023-24(12Y UP)
00069237701COMIRNATY 2023-24(12Y UP)
00069237710COMIRNATY 2023-24(12Y UP)
59267431501PFIZER COVID 2023-24(6M-4Y)
59267431502PFIZER COVID 2023-24(6M-4Y)
59267433101PFIZER COVID 2023-24(5-11Y)
59267433102PFIZER COVID 2023-24(5-11Y)
80777010201SPIKEVAX 2023-24 (12Y UP)
80777010204SPIKEVAX 2023-24 (12Y UP)
80777010293SPIKEVAX 2023-24 (12Y UP)
80777010295SPIKEVAX 2023-24 (12Y UP)
80777010296SPIKEVAX 2023-24 (12Y UP)
80777028707MODERNA COVID 23-24(6M-11Y)
80777028792MODERNA COVID 23-24(6M-11Y)
80631010501NOVAVAX COVID 2023-24
80631010502NOVAVAX COVID 2023-24