This bulletin applies to NC Medicaid Direct and NC Medicaid Managed Care.
PREP Act Extension
The Public Readiness and Emergency Preparedness (PREP) Act, initially set to expire on Dec. 31, 2024, has been extended through Dec. 31, 2029.
This update supersedes any guidance regarding NC Medicaid only covering pharmacy Point-of-Sale (POS) claims for COVID-19 vaccines for beneficiaries aged 3 and older through Dec. 31, 2024, as previously outlined in the following bulletins:
- Dec. 12, 2023: Point-of-Sale (POS) Vaccine Reimbursement Updates
- Nov. 19, 2024: COVID-19 Vaccine and Reimbursement Guidelines 2024-2025
Updated Reimbursement Policy
Effective Jan. 1, 2025, NC Medicaid will reimburse pharmacy providers for the administration and ingredient costs of the following vaccines at POS for beneficiaries aged 3 and older, in accordance with Center for Medicare & Medicaid Services (CMS) guidance:
- COVID-19 vaccines
- Seasonal influenza vaccines
Key Requirements:
Pharmacies must administer non-VFC (Vaccines for Children) COVID and/or flu vaccines to qualify for reimbursement.
What This Means for Pharmacy Providers
Pharmacy providers authorized under the PREP Act declaration are eligible for Medicaid reimbursement for both the non-VFC vaccine dose and its administration.
Providers do not need to be enrolled as VFC providers to qualify for reimbursement of non-VFC vaccines.
COVID-19 Pharmacy Coverage Information:
| Drug Description | Effective Date (For updated Age Span) | NDCs | Dose | Age Span (years) |
|---|---|---|---|---|
| COMIRNATY 2024-25(12Y UP) SYRG | 1/1/2025 | 00069-2432-01 00069-2432-10 | 0.30 | 12 and up |
| MODERNA COVID 24-25(6M-11Y)EUA | 1/1/2025 | 80777-0291-09 80777-0291-80 80777-0291-81 | 0.25 | 3-11 |
| NOVAVAX COVID 2024-25 SYR(EUA) | 1/1/2025 | 80631-0107-01 80631-0107-10 | 0.50 | 12 and up |
| PFIZER COVID 2024-25(5-11Y)EUA | 1/1/2025 | 59267-4438-01 59267-4438-02 | 0.30 | 5-11 |
| PFIZER COVID 2024-25(6M-4Y)EUA | 1/1/2025 | 59267-4426-01 59267-4426-02 | 0.30 | 3-4 |
| SPIKEVAX 2024-25 (12Y UP) SYRG | 1/1/2025 | 80777-0110-01 80777-0110-93 80777-0110-96 | 0.50 | 12 and up |
Seasonal Influenza Pharmacy Coverage Information:
| Drug Description | Effective Date (For updated Age Span) | NDCs | Dose | Age Span (years) |
|---|---|---|---|---|
| AFLURIA TRIVA 2024-25 (3YR UP) | 1/1/2025 | 33332-0024-03 33332-0024-04 | 0.50 | 3 and up |
| AFLURIA TRIVALENT 2024-25 VIAL | 1/1/2025 | 33332-0124-10 33332-0124-11 | 0.50 | 3 and up |
| FLUARIX TRIVALENT 2024-25 SYRG | 1/1/2025 | 58160-0884-41 58160-0884-52 | 0.50 | 3 and up |
| FLUBLOK TRIVALENT 2024-25 SYRG | 1/1/2025 | 49281-0724-10 49281-0724-88 | 0.50 | 18 and up |
| FLUCELVAX TRIVAL 2024-2025 SYR | 1/1/2025 | 70461-0654-03 70461-0654-04 | 0.50 | 3 and up |
| FLUCELVAX TRIVAL 2024-2025 VL | 1/1/2025 | 70461-0554-10 70461-0554-11 | 0.50 | 3 and up |
| FLULAVAL TRIVALENT 2024-25 SYR | 1/1/2025 | 19515-0810-41 19515-0810-52 | 0.50 | 3 and up |
| FLUMIST TRIVALNT NASAL 2024-25 | 1/1/2025 | 66019-0311-00 66019-0311-10 | 1.00 | 3-49 |
| FLUZONE TRIVALENT 2024-25 SYRG | 1/1/2025 | 49281-0424-50 49281-0424-88 | 0.50 | 3 and up |
| FLUZONE TRIVALENT 2024-25 VIAL | 1/1/2025 | 49281-0641-15 49281-0641-78 | 0.50 | 3 and up |