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Commercialized COVID-19 Vaccines Covered Through Pharmacy Benefit

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The Texas Health and Human Services Commission (HHSC) now covers certain new commercial COVID-19 vaccines through the pharmacy benefit in Texas Medicaid and the Children’s Health Insurance Program (CHIP).

The following COVID-19 vaccines were recently approved by the U.S. Food and Drug Administration (FDA) for Emergency Use Authorization (EUA):

  • FDA approval granted on September 11, 2023:
  • 2023–2024 Pfizer-BioNTech COVID-19 vaccine
  • 2023–2024 Moderna COVID-19 vaccine
  • FDA approval granted on October 3, 2023:
  • 2023–2024 Novavax COVID-19 vaccine

The vaccines include a monovalent (single) component that corresponds with the Omicron variant XBB.1.5. Unlike previous doses that were provided at no cost, commercialized COVID-19 vaccines are for purchase.

HHSC began covering these vaccines for traditional fee-for-service Medicaid on November 20, 2023. Coverage for CHIP and Medicaid managed care organizations (MCOs) will begin no later than December 5, 2023.

Note: HHSC backdated the effective date of formulary coverage to match the FDA approval dates below:

  • September 11, 2023, for the Pfizer and Moderna vaccines
  • October 3, 2023, for the Novavax vaccine

Refer to the Vendor Drug Program web page for the list of national drug codes (NDCs).

Email vdp-formulary@hhsc.state.tx.us with comments or questions.