Ensuring Continued Access To Safe Medications During COVID-19 Pandemic
We are committed to the safety of our patients at all times. We continue to monitor federal and state actions related to COVID-19. On the federal level, we are reviewing guidance from HHS (including CMS), the CDC and the White House. For states, we are staying up-to-date on all shelter-in-place restrictions and reopening plans. We also continue to review the state directives from the Departments of Insurance and the Boards of Pharmacy.
Most importantly, all service teams across all lines of business as well as our Mail Order and Specialty Pharmacies are making sure you get the medication you need!
Important Updates on COVID-19
- We continue to implement updates to Medicare Plans as recommended in the CMS CARES ACT.
- Elixir's response to all CMS guidance will continue to be communicated in our Weekly HPMS Memo Action Tracker each Wednesday.
COVID-19 Vaccine Frequently Asked Questions
On December 11, 2020, the U.S. Food and Drug Administration (FDA) issued an emergency use authorization (EUA) allowing the Pfizer-BioNTech COVID-19 vaccine to be distributed in the U.S. And on December 18, 2020, the FDA issued an EUA allowing the Moderna COVID-19 vaccine to be distributed in the U.S.
Both vaccines require two doses to be administered at different intervals. The vaccine itself will be paid for through funding authorized by the CARES Act. Members will not have to pay anything for the COVID-19 vaccine or the administration of it.
Q: Will I be able to get the COVID-19 vaccine at my network pharmacies?
A: Yes. Once the vaccine is available to pharmacies in your network, claims for the administration of the vaccine for non-Medicare members will process through Elixir at $0 member copay. However, in Phase 1, COVID vaccinations will likely be focused on healthcare workers and long-term care facilities and people over 65 with chronic health conditions. In Phase 1, the vaccine will not be widely available to the general public. As supply of the vaccine increases, broader access will become available.
Q: Why won’t it be widely available?
A: Currently, the Centers for Disease Control and Prevention (CDC) has recommended that healthcare personnel and seniors living in long-term care facilities be prioritized for the first phase. Additional information about the CDC’s distribution guidance can be found here.
Q: What will the COVID-19 vaccine cost?
A: Members will receive both doses of the vaccine at no copay/cost share or deductible. The federal government has purchased the initial supply of vaccines, so the vaccine itself will be paid for through funding authorized by the CARES Act. Some pharmacies may charge an administration fee, but that should be paid for by your plan.
Q: Will the price be different if I have to go to an out-of-network (OON) pharmacy?
A: No. Members will receive both doses of the vaccine at no copay/cost share or deductible and will not be charged an administration fee.
Q: Will COVID-19 vaccines be covered by Medicare?
A: Yes. For beneficiaries enrolled in Medicare Advantage plans during CY 2020 and 2021, payment for the COVID-19 vaccine and its administration will be made through the original fee-for-service Medicare program.
Q: Will members be able to submit a Direct Member Reimbursement (DMR) if they are required to pay the pharmacy for the administration fee?
A: Since members will receive the vaccine at no copay/cost share or deductible, there is no need for a DMR.
Q: Will the vaccine be restricted to certain pharmacies?
A: Yes. To receive free supplies of COVID-19 vaccines, pharmacies, retail clinics, providers, and any other site of care receiving and administering COVID-19 vaccines must sign an agreement with the U.S. government. They must also administer the vaccine in accordance with CDC and ACIP requirements and must meet storage and recordkeeping requirements, including recording the administration of the vaccine to patients in their own systems.
Q: How will COVID-19 vaccines work?
Q. Will the COVID-19 vaccine be like the flu vaccine and require annual dosing?
A: COVID-19 vaccines will work like other vaccines, which expose recipients to antigens. These antigens help those who are vaccinated to develop an immune response that will be able to block or kill the virus if a person becomes infected. Although some vaccines can provide long-lasting immunity, we do not yet have enough information to evaluate the duration of protection from the COVID-19 vaccine.
A: The need for and timing of booster doses for COVID-19 vaccines has not been established. No additional doses beyond the two-dose primary series are recommended at this time. However, scientists will continue to collect data to determine if changes are needed.
Q: Most vaccines take years to develop. How have we been able to speed up development for a COVID-19 vaccine and has that affected its safety?
A: It’s correct that vaccine development typically takes years. However, in this case, developers were able to speed up the process, in part because of efforts that had been underway on previously known coronaviruses (SARS-CoV-1 and MERS CoV). In addition, the U.S. government aided the process by invoking emergency authority to enable manufacturing to start while the clinical trials were ongoing. Data collected from thousands of participants in clinical trials help the FDA determine the safety of the vaccine. Both of the vaccines currently available have been shown to be safe and effective.
Q: What is emergency use authorization?
A: An EUA is a way to facilitate the availability and use of medical countermeasures, including vaccines, during public health emergencies. Under an EUA, the FDA may allow unapproved medical products, or unapproved uses of approved medical products, in an emergency to diagnose, treat or prevent serious or life-threatening diseases or conditions.
Q: What are some of the clinical details about these vaccines?
A: The two currently offered vaccines have different clinical profiles, but both are messenger RNA vaccines, or mRNA vaccines. These utilize a new approach to protecting against infectious diseases and will be the first of their kind to be licensed in the United States. The two vaccines are not interchangeable; both required doses have to be the same vaccine.
The CDC advises that vaccine providers observe patients with a history of allergic reactions (due to any cause) for 30 minutes after vaccination. All other persons should be observed for 15 minutes after vaccination to monitor for the occurrence of immediate adverse reactions. The CDC also states that appropriate medical treatment must be immediately available to treat a patient who experiences a severe allergic reaction to the vaccine.
Q: Will COVID-19 vaccines be available at Rite Aid locations?
A: Yes. In Phase 2, vaccines will be distributed to Rite Aid and other Vaccination Program Providers by the CDC. Rite Aid is staged and ready to distribute a vaccine to our customers (aged 18 and up) immediately upon receipt of the vaccine.
Q: Does Elixir Mail Order Pharmacy have the vaccine?
A: No. As a mail order pharmacy, Elixir Pharmacy is unable to administer the vaccine directly to members.
How to Ensure You Continue To Receive Your Medication/s Safely:
- Refill online. Use your preferred pharmacy's website or phone number to refill prescriptions for retail and/or home delivery.
- Use mail order. For current mail order and specialty patients:
- To request refills of your Elixir Mail medications, log in to the portal at elixirsolutions.com.
- For refills of your Elixir Specialty Pharmacy medications, please call a Care Coordinator at 877-437-9012 to order a refill or to set up online ordering. Our Call Center regular business hours are Monday through Friday 8:00 am-4:30 pm EST.
- Stay in your car. If you need to go to the retail pharmacy, use the drive through where available for convenience and social distancing.
- Ask about home delivery. Your pharmacy may provide delivery to your home; there may be additional charges. Ask your pharmacy.
- Running low? If you are concerned about running low on medication, ask your pharmacist about filling the medications you need.
- Ask about 90-day prescription fills. If your plan allows you to fill a 90 day supply, ask your pharmacy to do so, or request your doctor send a mail order prescription for 90-days to be filled.
- Approvals are still required. Some medications require prior authorization from your doctor. At this time, all existing prior authorization rules are still in place. If your plan sponsor opts to change these rules, we will implement them on a plan-by-plan basis.
- Don’t worry. We are monitoring any drug shortages.
- Both our home delivery and specialty pharmacy have dramatically increased normal medication supply levels to ensure no interruption in therapy.
Members, Clients, Pharmacies And Providers Can Engage Customer Care Via:
- Call our dedicated toll-free number, 800-361-4542.
- For Elixir Pharmacy, call 866-909-5170 (TTY: 711) 24 hours daily.
- Please note: Call volume may be high during certain times of the day.
- Elixir's mobile app is available in your device's app store.
- Members who currently use Elixir Specialty Pharmacy can manage specialty prescriptions and chat with Care Navigators through the Citus Health app, which is available in your device's app store.
- Member Portal
- Register/log in to the member portal
- Use your member ID to gain access
- Review your coverage
- Find in-network pharmacies
- Display/print your ID card
- Get drug pricing
- View your claims history
What We Are Doing To Help You Stay Safe
- Expanded on our already extraordinary measures to keep our facilities clean
- Provided additional training to employees on cleaning workstations and recognizing symptoms of the virus
- Implemented a companywide work-from-home policy for non-service positions to help contain the spread of the virus
- Increased our normal medication supply levels
We will continue to monitor this situation and implement any necessary measures to keep our employees safe and healthy so that they, in turn, can provide the best quality services to you.