November 01, 2019
Area(s) of Interest:
Public Health Public Payors
The Center for Medicare and Medicaid Services (CMS) recently published Medicare’s influenza vaccine payment allowances and effective dates for the 2019-2020 flu season.
The Medicare Part B payment allowance limits for seasonal influenza and pneumococcal vaccines are calculated at 95% of the average wholesale price.
The payment allowances and effective dates for the 2019-2020 flu season are as follows:
| Code |
Labeler Name |
Drug Name |
Payment Allowance |
Effective Dates |
| 90653 |
Seqirus |
Fluad (2019/2020) |
$59.530 |
08/01/2019 - 07/31/2020 |
| 90662 |
Sanofi Pasteur |
Fluzone High-Dose (2019/2020) |
$56.006 |
08/01/2019 - 07/31/2020 |
| 90672 |
MedImmune |
FluMist Quadrivalent (2019/2020) |
$26.876 |
08/01/2019 - 07/31/2020 |
| 90674 |
Seqirus |
Flucelvax Quadrivalent (2019/2020) |
$28.130 |
08/01/2019 - 07/31/2020 |
| 90682 |
Sanofi Pasteur |
Flublok Quadrivalent (2019/2020) |
$56.006 |
08/01/2019 - 07/31/2020 |
| 90685 |
Sanofi
Pasteur
Seqirus |
Fluzone Quadrivalent
0.25ml (2019/2020)
(Pres Free)
Afluria Quadrivalent
0.25ml (2019/2020)
(Pres Free)
|
$20.343 |
08/01/2019 - 07/31/2020 |
| 90686 |
GlaxoSmithKline
Sanofi Pasteur
Seqirus |
Fluarix Quadrivalent
(2019/2020)
(Pres Free)
Flulaval Quadrivalent
(2019/2020)
(Pres Free)
Fluzone Quadrivalent
(2019/2020)
(Pres Free)
Afluria Quadrivalent
(2019/2020)
(Pres Free)
|
$19.032 |
08/01/2019 - 07/31/2020 |
| 90687 |
Sanofi Pasteur
Seqirus |
Fluzone Quadrivalent
0.25ml (2019/2020)
Afluria Quadrivalent
0.25ml (2019/2020)
|
$9.403 |
08/01/2019 - 07/31/2020 |
| 90688 |
GlaxoSmithKline
Sanofi Pasteur
Seqirus |
Flulaval Quadrivalent
(2019/2020)
Fluzone Quadrivalent
(2019/2020)
Afluria Quadrivalent
(2019/2020)
|
$17.835 |
08/01/2019 - 07/31/2020 |
| 90756 |
Seqirus |
Flucelvax Quadrivalent
(2019/2020) |
$26.657 |
08/01/2019 - 07/31/2020 |
More information on 2019-2020 influenza vaccine pricing is available on the CMS website.
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