Provider Alert! Spikevax COVID-19 Vaccine Coverage Update

Date: June 3, 2022

Attention: All Providers

Effective Date: June 1, 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: TCHP (Texas Children’s Health Plan) would like to inform providers that on January 31, 2022, the U.S. Food and Drug Administration (FDA) issued full approval of the Moderna COVID-19 Vaccine, now marketed as Spikevax, for individuals 18 years of age and older.

How this impacts providers: Spikevax has the same formulation as the emergency use authorization (EUA) Moderna COVID-19 vaccine and the same administration schedule. The primary series of two doses are given by a healthcare provider one month apart. The original Moderna COVID-19 vaccine is also available under the EUA. Spikevax can be used interchangeably with the EUA Moderna COVID-19 Vaccine without any safety or effectiveness concerns.

HHSC updated the Medicaid and Children’s Health Insurance Program (CHIP) pharmacy benefit coverage for the Spikevax COVID-19 vaccine.

Spikevax is the brand name for the Moderna COVID-19 vaccine and has unique National Drug Codes (NDC). Beginning June 1, 2022, Medicaid will cover the brand name Spikevax COVID-19 Vaccine NDCs in the table below for Medicaid and CHIP as a payable pharmacy benefit.

The Health and Human Services Commission (HHSC) HHSC will cover the administration of the COVID-19 vaccine as non-risk and continue to follow the COVID-19 non-risk payment (NRP) process.

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.