Provider Alert! Booster Dose Moderna COVID-19 Vaccine for Adults Added to the Formulary

Date: May 31, 2022

Attention: All Providers

Effective Date: May 13, 2022

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that the U.S. Food and Drug Administration (FDA), under an emergency use authorization (EUA), authorized the Moderna COVID-19 vaccine to prevent COVID-19 in individuals 18 years and older. The manufacturer of the Moderna COVID-19 vaccine has developed a new booster dose-only formulation also authorized under the EUA for individuals 18 and older.

How this impacts providers: On May 13, 2022, HHSC added formulary coverage for the new booster dose-only formulation of the Moderna COVID-19 Vaccine. The following national drug codes (NDCs) were added to the formulary for Medicaid and CHIP as a reimbursable pharmacy benefit:

HHSC continues to cover the vaccine administration based on the Medicare rate for vaccine administration as non-risk. As a reminder, there is currently no ingredient cost associated with the vaccine.

Next steps for providers: Prescribers should share this communication with their staff.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers