The ACIP and CDC recently recommended two new vaccines for use in adults:

Capvaxive™ (21-Valent Pneumococcal Conjugate Vaccine)

Merck’s Capvaxive™ (PCV21) is recommended as an option for adults already recommended to receive a pneumococcal conjugate vaccine. It can be billed under the new CPT code 90684. Members who are already linked to the CPP Merck contract will automatically receive the member discount on this new vaccine.

For more information about PCV21, click here or contact your Merck representative.

mRESVIA® (mRNA RSV Vaccine)

Moderna’s FDA approved RSV vaccine mRESVIA® is recommended as an option for adults already recommended to receive an RSV vaccine. It can be billed under the new CPT code 90683. Members who are already linked to the CPP Moderna contract will automatically receive the member discount on this new vaccine.

For more information about mResvia®, click here or contact your Moderna representative.

If your practice is not yet linked to Merck or Moderna and would like to access discounts on these new vaccines, contact the CPP office for detailed instructions for how to enroll. 

It is anticipated that CMS will add these new vaccines to their fee schedule effective October 1, 2024. We also expect that private payers will be working to incorporate them into their payment schedules in the coming months. Please reach out to your major payers to verify adequate payment is in place for these new CPT codes before administering them in your office.

CPP has also updated its Adult coding cheat sheets to include the new codes as well as the Adult immunization schedule.  

CPP members who participate in the Pfizer vaccine contract can now access a discount on Pfizer’s LUCIRA®, a 2-in-1 molecular rapid test for detection of COVID-19, Influenza A, and Influenza B from nasal swab samples in individuals with known or suspected COVID-19 or flu symptoms.

To learn more details about Lucira®, click here or contact your Pfizer representative.

If you wish to participate in this discount opportunity and are not already linked to the CPP Pfizer contract, please contact the CPP office.

Beyfortus® Ordering

For members who participated in the Beyfortus® Reservation Program, please remember to place your reservations to schedule your shipments throughout the 2024-2025 RSV season.

If you didn’t get a chance to participate in the reservation program, you still have a chance to order Beyfortus® during the normal ordering window from September 2024 through February 2025.

To order, visit vaccineshop.com and place an order as you usually would beginning in September. Normal ordering terms and conditions are as follows:

• Order Now/Ship Now Only: no ability to schedule future shipments
• Payment terms are limited to 60 days

Coding, Coverage and Reimbursement for Beyfortus®

Sanofi will be hosting several webinars in September that will cover important topics, including:

• Beyfortus® coverage information for most major health plans
• Review of the national reimbursement landscape
• Recently released administration codes specific to Beyfortus®
• How to code & bill for Beyfortus®
• Benchmarks for setting charges
• Resources Sanofi offers to assist you with coverage, coding, and billing for Beyfortus®

 For a list of dates/times and to register click here.

RSV Collaboration Toolkit

Babies born during the RSV season can be immunized against RSV one of two ways:

• Maternal vaccination with Pfizer’s Abrysvo™ at 32-36 weeks gestation
• Infant immunization with Sanofi’s Beyfortus®

This presents a tremendous opportunity for Pediatricians and OBGYNs to collaborate to prevent RSV in babies born during the season while avoiding duplicative work and cost.

To assist our members in communicating with OBGYN offices, CPP is providing the following resources to encourage collaboration: 

• Letter Template to OBGYNs – Customize this letter to OBGYN practices in your community to gauge their interest in recommending and/or providing RSV vaccination to their pregnant patients. Your anticipated demand for Beyfortus® will be directly impacted by their plans to recommend RSV immunization and whether or not they are providing Abrysvo® in their office.

• Immunization Status Card – Ask your OBGYN counterparts to provide immunization administration cards to mothers who have been vaccinated so they can give it to you at the baby’s first visit in your office. Knowing the mother’s vaccination status and dose administration date will help determine if the infant will need a dose of Beyfortus®. Feel free to add your logo and contact information to the back so they think of you when scheduling their first visit with a pediatrician! (Attached template is for perforated card stock - Avery # 74541.)

If you have OBGYN partners in your community who are struggling with vaccine management, please let them know about CPP! They can reach out to us at cpp@nationwidechildrens.org and we will be happy to assist with anything from vaccine cost management to storage solutions to billing & coding resources.