COVID-19 Vaccine Toolkit

Emergency use authorizations and FDA approvals

All vaccines must receive Emergency Use Authorization (EUA) or approval from the U.S. Food and Drug Administration (FDA) before they can be distributed to the public.

  • EUAs can be used by the FDA during public health emergencies to provide access to medical products that may be effective in preventing, diagnosing or treating a disease, provided that the FDA determines that the known and potential benefits of a product, when used to prevent, diagnose or treat the disease, outweigh the known and potential risks of the product.
  • FDA-approved vaccines undergo the agency’s standard process for reviewing the quality, safety and effectiveness of medical products.

COVID-19 vaccines

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Coverage for our members

  • COVID-19 vaccines will be covered as preventive care with no member cost for most health plans if received from an in-network provider. Members receiving vaccines from out-of-network providers may have to pay cost shares.
    • Note: Providers must submit claims for the vaccine using the appropriate codes.
  • Paxlovid will be covered on the non-preferred brand tier.

Claims submission

Claims for the vaccine administration and COVID-19 vaccines (drugs) purchased by the provider or pharmacy should be submitted to Regence.

Note: Retail pharmacies can file vaccine claims under the medical or pharmacy benefits for commercial members.

Codes and reimbursement

The American Medical Association, CMS and the CDC collaborated to establish CPT codes and reimbursement for the COVID-19 vaccines, as well as the administration.