Vaccine Coverage, Pricing, and Reimbursement in the U.S.
| Table 1: Estimated Price of Initial Doses of COVID-19 Vaccines Purchased by the U.S. Government | |||
| Company/Candidate | Price per Dose/Regimen | Agreement Amount | Number of Doses Owned by Federal Government |
| AstraZeneca AZD1222 Adenovirus-vector vaccine |
$8 for two-dose regimen | Up to $1.2 billion | 300 milliona |
| Janssen (Johnson & Johnson) AD26.COV2.S Adenovirus-vector vaccine |
$10 for one dose regimen | $1 billion | 100 million |
| Merck/IAVIb V591 Recombinant vesicular stomatitis virus (rVSV) vector vaccine |
n/a | $38 million | None reported |
| Moderna mRNA-1273 RNA vaccine |
$30 for two-dose regimen | $1.5 billion | 100 million |
| Novavax NVX-CoV-2373 recombinant protein vaccine |
$32 for two-dose regimen | $1.6 billion | 100 million |
| Pfizer BNT162b2 RNA vaccine |
$39 for two-dose regimen | $1.95 billion | 100 million |
| Sanofi/GlaxoSmithKline Recombinant SARS-CoV-2 Protein Antigen + AS03 Adjuvant |
$20 for one dose, $40 for two dose regimenb | $2 billion | 100 million |
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a. The agreement between the federal government and AstraZeneca states that “at least 300 million doses will be made available” to the government with up to $1.2 billion in government support.
b. Sanofi/GlaxoSmithKline and Merck/IAVI vaccine trials are testing 1 and 2 dose regimens. Source: J. Kates and J. Michaud, “Distributing a COVID-19 Vaccine Across the U.S. – A Look at Key Issues,” KFF, Oct 20, 2020.
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| Table 2: Overview of How Vaccine Prices Are Set | |
| Program or Type of Coverage | Summary of how vaccines prices are set |
| Medicare | For the influenza and pneumococcal vaccines covered under Medicare Part B, reimbursement is set at 95% of average wholesale price. For vaccines covered by Medicare Part D, private Part D plans and pharmacy benefit managers can negotiate with manufacturers to get rebates and other price concessions to lower the net price of vaccines. |
| Private Insurance | Health insurers and pharmacy benefit managers can try to negotiate with manufacturers to get rebates and other price concessions to lower the net price of vaccines. |
| Vaccines for Children | The Secretary of HHS negotiates the price of vaccines and purchases doses that are then distributed across the country. |
| Medicaid | States set provider reimbursement for vaccines. Vaccines are not eligible for Medicaid rebates. |
| Section 317 | CDC negotiates the price of vaccines and purchases doses that are then distributed across the country. |
| VA | As with other prescription drugs, the VA receives a minimum discount that is set by law. The VA is allowed to try to negotiate deeper discounts with manufacturers. |
| Table 3: Vaccine Costs Across Key Federal Programs | |||||||
| Vaccine | Brand Name | List Price / Dose | CDC Adult Vaccine Price | VFC Price | VA Cost/ Dose | Medicare Cost/ Dose | |
| Hib | ActHIB® | $17 | N/A | $10 | $7 | $35** | |
| Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis | Adacel® | $47 | $25 | $33 | $25 | $57** | |
| Influenza (Age 6 months and older) | Afluria® Quadrivalent | $17 | $12 | $12 | $12* | $10-$21 | |
| MENB – Meningococcal Group B | Bexsero® | $179 | $107 | $120 | $107 | $189** | |
| Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis | Boostrix® | $42 | $25 | $33 | $25 | $60** | |
| DTaP | Daptacel® | $32 | N/A | $19 | $15 | $63** | |
| Hepatitis B Adult | Engerix B® | $62 | $26 | N/A | $37 | $70 | |
| Hepatitis B (Pediatric) | Engerix B® | $25 | N/A | $15 | $13 | $28 | |
| Influenza (Age 6 months and older) | Fluarix® Quadrivalent | $17 | $12 | $14 | $13 | $20 | |
| Influenza (Age 4 years and older) | Flucelvax® Quadrivalent | $24 | $14 | $15 | $14* | $28 | |
| Influenza (Age 6 months and older) | FluLaval Quadrivalent | $17 | $12 | $14 | $13 | $20 | |
| Influenza Live, Intranasal (Age 2-49 years) | FluMist® Quadrivalent | $24 | $16 | $19 | $17* | $27 | |
| Influenza (Age 6 months and older) | Fluzone® Quadrivalent | $17 | $13 | $14 | $13 | $10-$21 | |
| HPV-Human Papillomavirus 9 Valent | Gardasil®9 | $228 | $141 | $187 | $141 | $241** | |
| Hepatitis A Adult | Havrix® | $72 | $33 | N/A | $36 | $84** | |
| Hepatitis A (Pediatric) | Havrix® | $34 | N/A | $21 | $20 | N/A | |
| Hepatitis B Adult | Heplisav-B™ | $121 | $73 | N/A | $78 | $131 | |
| Hib | Hiberix® | $11 | N/A | $9 | $8 | $18** | |
| DTaP | Infanrix® | $25 | N/A | $19 | $15 | $45** | |
| e-IPV | IPOL® | $35 | N/A | $14 | $19 | $56** | |
| DTaP-IPV | Kinrix® | $54 | N/A | $42 | $29 | $78** | |
| Meningococcal Conjugate (Groups A, C, Y and W-135) | Menactra® | $128 | $75 | $96 | $76 | $144** | |
| Meningococcal Conjugate (Groups A, C, Y and W-135) | Menveo® | $135 | $70 | $96 | $70 | $131** | |
| Measles, Mumps, & Rubella | M-M-R®II | $79 | $49 | $22 | $49 | $90** | |
| DTaP-Hep B-IPV | Pediarix® | $83 | N/A | $61 | $46 | $103** | |
| Hib | PedvaxHIB® | $26 | N/A | $14 | $19 | $49** | |
| DTaP-IP-HI | Pentacel® | $100 | N/A | $62 | $46 | $100** | |
| Pneumococcal Polysaccharide (23 Valent) | Pneumovax®23 | $105 | $63 | $59 | $63 | $120 | |
| Pneumococcal 13-valent | Prevnar 13™ | $202 | $132 | $144 | $132 | $230 | |
| MMR/Varicella [2] | ProQuad® | $225 | N/A | $138 | $137 | $224** | |
| DTaP-IPV | Quadracel™ | $55 | N/A | $42 | $29 | N/A | |
| Hepatitis B Adult | Recombivax HB® | $61 | $25 | N/A | $26 | $70 | |
| Hepatitis B (Pediatric) | Recombivax HB® | $24 | N/A | $13 | $9 | $28 | |
| Rotavirus, Live, Oral, Oral | Rotarix® | $125 | N/A | $98 | $70 | N/A | |
| Rotavirus, Live, Oral, Pentavalent | RotaTeq® | $85 | N/A | $72 | $55 | N/A | |
| Zoster Vaccine Recombinant, Adjuvanted | Shingrix® | $151 | $102 | N/A | $102 | $161** | |
| Tetanus and Diphtheria Toxoids | TDVAX™ | $26 | $16 | $16 | $16* | $39** | |
| Tetanus and Diphtheria Toxoids | Tenivac® | $35 | N/A | $21 | $16 | $50** | |
| MENB – Meningococcal Group B | Trumenba® | $150 | $93 | $114 | $94 | $167** | |
| Hepatitis A-Hepatitis B Adult | Twinrix® | $109 | $62 | $63 | $62 | $120** | |
| Hepatitis A Adult | Vaqta® | $70 | $33 | N/A | $36 | $89** | |
| Hepatitis A (Pediatric) | Vaqta® | $33 | N/A | $21 | $18 | N/A | |
| Varicella | Varivax® | $136 | $82 | $109 | $82 | $142** | |
| NOTES: VFC is Vaccines for Children. * is the listed price for the Federal Supply Schedule because no VA/Big Four price was listed. ** is the listed price for drugs covered under Medicare Part D and does not account for rebates. The Part B prices for Engerix-B, Recombivax HB, and Prevnar 13 are listed because that vaccine is typically covered under Medicare B; although a relatively small number of beneficiaries do receive the vaccine through Part D because they do not meet the Part B coverage criteria. In general, Medicare vaccine pricing data does not distinguish between adult and pediatric versions of a vaccine. The list price per dose is the wholesale acquisition cost and sometimes also includes the federal excise tax, which is between $0.75 and $2.25. That price is taken from the CDC’s price list and is listed there as the “Private Sector Cost/ Dose.” For simplicity, in cases where two different versions of the same vaccine have prices that vary by $2 or less, we only display the lower price. These different prices are typically for different types of packaging for the same vaccine (for example: syringe vs vial). SOURCE: Medicare cost for vaccines covered through Medicare Part B are taken from the 2020 ASP file and Seasonal Influenza Vaccines Pricing List; Part D prices come from the 2018 Part D spending dashboard. CDC adult vaccine price and VFC price come from the CDC Vaccine Price List https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html. The list prices come from the CDC Vaccine Price List and are the “Private Sector Cost/Dose” https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html. The VA/Big Four and federal supply schedule prices are taken from the VA’s Office of Procurement, Acquisition and Logistics and are available here: https://www.va.gov/opal/nac/fss/pharmPrices.asp. |
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