PREVNAR 13 safety information

IMPORTANT SAFETY INFORMATION

  • Severe allergic reaction (eg, anaphylaxis) to any component of Prevnar 13® or any diphtheria toxoid–containing vaccine is a contraindication
  • Immunocompromised individuals or individuals with impaired immune responsiveness due to the use of immunosuppressive therapy may have reduced antibody response
  • In adults, antibody responses to Prevnar 13® were diminished when given with inactivated trivalent influenza vaccine (TIV)
  • In adults, the commonly reported solicited adverse reactions were pain, redness, and swelling at the injection site, limitation of arm movement, fatigue, headache, muscle pain, vomiting, joint pain, decreased appetite, chills, or rash

INDICATIONS

  • Prevnar 13® is a vaccine indicated for active immunization for the prevention of disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F
  • In adults 50 years and older for pneumococcal pneumonia and invasive disease. Indication is based on immune responses
  • In children 6 weeks through 17 years for invasive disease caused by the 13 serotypes, and for children 6 weeks through 5 years of age for otitis media caused by 7 of the 13 serotypes only (4, 6B, 9V, 14, 18C, 19F, and 23F)

Limitations of Use and Effectiveness

  • Prevnar 13® will only help protect against S pneumoniae serotypes in the vaccine
  • Effectiveness when administered <5 years after pneumococcal polysaccharide vaccine is not known

You are encouraged to report negative side effects of vaccines to the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). Visit www.vaers.hhs.gov or call 1-800-822-7967.

Please see full Prescribing Information for Prevnar 13®.

ACIP=Advisory Committee on Immunization Practices; CDC=Centers for Disease Control and Prevention.

Medicare coverage and reimbursement

Prevnar 13® is covered by the Medicare Part B fee-for-service (FFS) benefit for adults aged 65+ with $0 in out-of-pocket costs

Medicare covers administration of 2 different pneumococcal vaccines for adults aged 65+.2 Prevnar 13® is covered for the following patient types:
Female aged 65
or older
Adults aged 65+ who are pneumococcal vaccine naïve
Male aged 65 or
older
Adults aged 65+ who were previously vaccinated with PPSV23 at least 1 year prior

Provided that the patient is competent, it is acceptable to rely on the patient’s verbal history to determine prior vaccination status.2

ACIP=Advisory Committee on Immunization Practices; CDC=Centers for Disease Control and Prevention; PPSV23=23-valent pneumococcal polysaccharide vaccine.

Medicare Advantage
Medicare Advantage plans, which represent approximately 30% of the total Medicare population, are required to cover services covered through Medicare FFS.3,4

As several factors may determine coverage and reimbursement, Pfizer suggests that you contact your Medicare Administrative Contractor (MAC), Medicare Advantage plan, or commercial plan to determine eligibility for specific patients.


Pfizer Vaccines Reimbursement Support Services

Telephone
The Pfizer Vaccines Reimbursement Support Services, available to both patients and healthcare providers, can be reached at 1-866-744-3198, Monday through Friday, between 8 AM and 8 PM ET
  • Pfizer Vaccines Reimbursement Support Services can help with the following:
  • —Roster billing
  • —Benefits investigation (verifies patient coverage)
  • —Prior authorization support (if needed)
  • —Claims denials/appeals support (if needed)

Coverage by state

Coverage map

STEP 2: Choose a state in the drop-down menu for information on how to contact your local provider and for directions on how to locate reimbursement rates for Prevnar 13®

Coding considerations for Prevnar 13®

Procedural coding for Prevnar 13®5,6
CPT®* code 90670
ICD-10 code Z23
Administration code Medicare Commercial plans
G0009 90471
  • Roster billing is permitted for Medicare FFS patients in hospitals. Only Medicare FFS beneficiaries are eligible
  • Both the Prevnar 13® vaccine and its administration are covered under Medicare Part B separate from the diagnosis-related group (DRG) rate for beneficiaries vaccinated during hospitalization
*CPT is a registered trademark of the American Medical Association (AMA).
Additional ICD-10 codes may be needed depending on the type of patient visit and for immunizations administered during inpatient care.