Best Practices for Building the Pharmacy's Infrastructure

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About: 

• This section are best practices that help to support the Change Packages and other Implementation guides.

Digital Data Logger (DDL) [updated 1.12.2021]

• A DDL is required for each storage device for COVID-19 Vaccines.

• We will continue to update as we receive new information. If you know of DDLs available, please email with company name and website to order or contact.

• For requirements of DDLs, view the December Change Package on the vaccine home page.

Best Practice: Reach out to your local Health Department to be a resource for Phase 1

• Click the link to view sample talking points created by CPESN Iowa in order to determine if they need or would like assistance in an earlier phase of the vaccine rollout.

  • CPESN Pharmacies that are utilizing CPESN USA as the Federal Pharmacy Partner during Phase 2 still applies.

  • This will allow you to be involved in the vaccine earlier on. 

• Utilize these ideas to create your own script and reach out to your local Health department.

Best Practice: Billing the Medical Benefit (not the PBM) for COVID-19 Vaccines

COVID has brought new opportunities and has more pharmacies interested in services that can be billed and paid for outside the PBM, from the medical benefit. COVID Vaccines are within this category.

Medical Billing Pathways: 

1. Medicare Part B (The information provided below is only for the Medicare Part B Pathway)

2. Medicaid

3. Commercial

4. Uninsured

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Medicare Part B Payment 

• Click here to view the CMS Medicare payment rates for COVID-19 vaccine administration.

Step 1: Ensure that your Pharmacy is enrolled with Medicare Part B

• If you are billing for immunizations (e.g., flu, pneumococcal) through Medicare Part B for reimbursement, you should have a PTAN for “Pharmacy” or “Mass Immunizer (Roster Biller).” 

• Double check through your PECOS online account.

Step 1a: Sign-in to your PECOS online account

Step 1b: Determine your “Existing Enrollments”

• If your existing enrollment is not “Pharmacy” or “Mass Immunizer (Roster Biller),” then you will need to “Create Initial Enrollment Application” for this enrollment.

• View enrollments (scroll down) to see how you are enrolled

Step 2: If your pharmacy is not enrolled with Medicare Part B, begin the enrollment process

• In order to enroll with Medicare Part B, the process can be started by 2 different methods:

  • Online Form (Click here): Enroll through PECOS by clicking link to left 

  • Paper Form (Click here: Complete and mail the CMS-855B Form: Linked to the left

NCPA's 3-pager COVID-19 Billing and Reimbursement

Click here

APhA's Resource for Reimbursement for Administration of COVID-19 Vaccine(s) - What We Know

Click here

Commercial Payment

• Pharmacies should consider workflow, transaction fees, reimbursement rates and timing of remittance when given the option of medical billing or PBM billing.

• The following are the current options in the market place:

  1. Change

  2. EBS​

  3. FDS

  4. OmniSYS

• Stay tuned for a comparison chart of these 4 platforms (or more if we become aware) ​

• Next Step for the pharmacy: Begin researching your options and sign up with a medical billing platform, which will allow you to bypass the PBM for vaccine administration fees.

Uninsured - HRSA

• Pharmacies must enroll as a provider participant with HRSA, check patient eligibility, submit patient information, and submit the claim in order to receive payment via direct deposit.

• Click here to get the process started. The link includes a step-by-step instructions to enroll with HRSA. Also, you can view NCPA's 3-pager.

  • Step 1: Validate Taxpayer Identification Number (TIN)​ - this can take 1-2 business days.

  • Step 2: Set Up Optum Pay Automated Clearing House (ACH) - this can take 7-10 business days.

  • Step 3: Add provider roster - this can take 5-7 business days.

Best Practice: Certified Immunizer Training Resources

• Check with your state associations for certification trainings for Pharmacists and Pharmacy Technicians

• Student Pharmacists (and Pharmacy Interns) should have the certification from their school/college of pharmacy.

  • After contacting your state association and confirming that no other pharmacy technician training is available (State Associations have the ability to license all 3 options at a state-level), review the 3 options below.

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The following training options exist:

• American Pharmacists Association (APhA)

  • Composed of an online self-study component combined with a live seminar that teaches hands-on immunization techniques.

  • CE Hours: 6 Hours

  • Cost: Stay tuned.

• CE Impact

  • This course consists of 3 hours of home-study, followed by a 2 hour live, virtual workshop. Pharmacy technician learners must attend the live, virtual workshop with a pharmacist immunizer present. As part of the live workshop, pharmacy technicians must demonstrate appropriate immunization technique by administering two injections to the pharmacist immunizer.

  • CE Hours: 5 Hours

  • Cost: $249

    • ​The CPESN Pharmacy discount code is available for the CPESN Pharmacy staff members by viewing the Workflows email send on 12/5/2020.

• Washington State Pharmacist Association (WSPA)

  • This online course is designed to prepare pharmacy technicians to administer immunizations subsequent to a prescription or order from a pharmacist or other prescriber.

  • CE Hours: 12.5 Hours

  • Cost: $175 CPESN Pharmacy Member Cost

    • The CPESN Pharmacy discount code is available for the CPESN Pharmacy staff members by viewing the Workflows email send on 12/5/2020.