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 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.
- For commercial members, Paxlovid will be covered on the non-preferred brand tier.
- For Medicare Advantage members, Paxlovid will be covered as a Tier 3 preferred drug.