MedicaidReimbursementMedium impact
CCO reimbursement of COVID-19 vaccine and vaccine administration expenses to contracted pharmacies
Oregon Health Plan·OR · Family Medicine, Internal Medicine, Pediatrics·Plan contract
Effective date
Sep 11, 2023
We identified it
Jun 20, 2026
Summary
Oregon Health Authority will reimburse CCOs for COVID-19 vaccine and administration expenses at fee-for-service rates: $40 for adults 19+, $21.96 for children under 19. Some CCOs are incorrectly paying pharmacies typical dispensing fees instead of the higher FFS rates for vaccine administration.
Action Required
Immediately: Billing team must verify that contracted pharmacies are being paid at least $40 for COVID-19 vaccine administration for members 19+ and $21.96 for members under 19 (VFC rate). Contact Pharmacy Benefit Managers to ensure proper payment rates are implemented. Review and reconcile any underpayments for COVID vaccine administration provided on or after 9/11/2023 to make pharmacies whole.