Vaccine Additional Payment Request

In collaboration with the Immunizations Committee of the Hawaii Chapter of the American Academy of Pediatrics, HMSA has developed a process for providing additional reimbursement to physicians when, due to unusual circumstances, costs for procuring vaccines exceed HMSA’s Maximum Allowable Charges.

This process was developed in response to shortages of some vaccines, resulting in physicians not being able to procure vaccines directly from the manufacturer. In these instances, the only alternative source of the vaccine was local wholesalers, who charge a higher price than the manufacturer. HMSA believes it is important to encourage physicians to immunize HMSA members and to enable physicians to cover their acquisition costs while providing this important service.

When unexpected or unusual situations (such as unanticipated shortages) occur, the physician may apply to HMSA for additional reimbursement to offset the higher costs of vaccine acquisition. To apply, please complete a copy of the Vaccine Additional Payment Request [PDF] form and fax it to HMSA as indicated on the form. Also attach a copy of your invoice showing the per-dose price that was paid for the vaccine.

When some of the vaccine acquired through higher-cost sources is administered to HMSA members and some of the vaccine is administered to members of other health plans, please indicate the estimated number of doses that will be administered to HMSA members.

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