COLUMBUS, Ohio — The federal government stopped paying pharmacies for administering COVID-19 vaccines to uninsured patients as lawmakers in Washington remain split on a legislative solution to a coronavirus funding gap.
Gerdes Pharmacy, a family-owned business in Conneaut, Ohio, was receiving $40 from the federal government for every vaccine shot it administered to an uninsured patient, pharmacist Scott Gerdes said.
But on April 5, HHS’s Health Resources & Services Administration (HRSA) uninsured program stopped accepting claims for COVID-19 vaccinations due to a lack of federal funds.
“Someone that has insurance. Nothing's changed on that end as of now,” Gerdes said. “Someone that's not insured, we still give the vaccine at no charge to the patient, we just don't get reimbursed anything for it, and obviously the vaccine itself is paid for by the government, but in terms of paying for our time and stuff like that, we just don't get paid for it.”
Gerdes said it’s a “hit” for the pharmacy to not get reimbursed. Overall, the vaccination program remains financially viable for their business because the issue affects only a portion of their patients. As of the latest CDC estimates for last summer, 8.9% of Americans were uninsured.
“Most of the people we've been giving shots to do have insurance and most of the country has insurance, but there definitely are some people that aren't, obviously, insured,” Gerdes said.
Ohio Department of Health spokesperson Ken Gordon said providers cannot charge uninsured residents for vaccines under the Centers for Disease Control and Prevention’s protocols.
“It is our understanding that many health care providers are still administering vaccines to Ohioans, regardless of their ability to pay. The CDC’s COVID-19 Vaccination Program requires participating providers to administer COVID-19 vaccines at no out-of-pocket costs to recipients,” he said.
Gordon encouraged uninsured residents to contact their provider to ensure vaccines are still available for them at no cost, and he said the department is monitoring the evolving situation at the federal level regarding a longer-term funding solution for vaccination, testing and treatments.
Pharmacies could choose to end their participation in the CDC vaccination program due to the lack of reimbursements for vaccinating the uninsured, but Gerdes said most pharmacies won’t make that decision.
“It's something we would like to do to offer to the community and even though we aren't getting paid for the uninsured patients at this time, it's still worth us being able to do it because of all the people that are insured,” he said. “If we were in an area that was heavily uninsured, like well over 50%, then we would have to maybe reconsider even doing it.”
Gerdes Pharmacy continues to take the same information from uninsured patients upon administering vaccines, hoping there will be a back-billing process if Congress approves additional funding for the uninsured program.
Gerdes said lawmakers need to come to a solution so that pharmacies can continue to make the vaccine accessible.
“If they’re going pay big drug companies like Pfizer and Moderna, which is relatively small compared to Pfizer, but if they're going to be paying them this big amount of money, they can afford to pay administration fees to pharmacies and other health care providers — providers that are actually making the vaccines happen,” he said.
Beyond vaccination reimbursements, the HRSA’s uninsured fund stopped accepting claims from providers for COVID-19 testing and treatment on March 22.
Some providers continue to offer free testing to uninsured people, but others are charging uninsured patients. Uninsured residents seeking COVID-19 testing can order free at-home tests from the federal government’s website Covidtests.gov.