Pfizer booster authorized for individuals in high-risk categories
In addition to the FDA’s August 12 authorization of a third Pfizer and Moderna vaccine dose for immunocompromised people, it has also authorized a Pfizer booster in certain populations to help increase protection against severe disease and complications from COVID-19. The CDC has issued this guidance about the Pfizer booster:
- People 65 years or older and residents in long-term care settings should get a booster (at least six months after the Pfizer primary series).
- People between the ages of 50 and 64 years with underlying medical conditions should get a booster (at least six months after the Pfizer primary series).
- Those ages 18 through 49 with underlying medical conditions may get a booster (at least six months after the Pfizer primary series), based on their individual benefits and risks.
- Those ages 18 through 64 who are at increased risk for coronavirus exposure and transmission because of their occupational or institutional setting may get a booster (at least six months after the Pfizer primary series), based on their individual benefits and risks.
Recommended time frames
- The recommended time frame for administering the Pfizer and Moderna third dose for the immunocompromised population is at least 28 days after the second shot.
- The Pfizer booster for high-risk individuals should be administered at least six months after the second shot.
Coverage, cost share, reimbursement, and billing
Blue Cross® Blue Shield® of Arizona (BCBSAZ) member cost share, provider reimbursement, and billing requirements for the authorized use of a third dose or booster will follow the same general guidelines currently in place for the first two doses of the vaccines. Please refer to our December 15, 2020, provider notice. We are updating our system to accommodate coverage and reimbursement for the recent FDA vaccine authorizations.
What about additional doses for the general public?
At this time, boosters for the general public have not been authorized by the FDA. Authorized use is still limited to the high-risk categories mentioned above, along with the highly immunocompromised as defined by the CDC. The CDC is expecting to review Moderna and Johnson & Johnson vaccine boosters as soon as data is available. For now, here are the recommendations:
If you have questions, please contact your provider liaison or call Provider Partnerships at 602-864-4231 or 1-800-232-2345, ext. 4231.