By Madison Bertrand, 2026 PharmD Candidate, University of Washington
Flu season is officially upon us!
It is one of the busiest times of year for pharmacies and CPG pharmacies are no exception. There is a lot involved when it comes to preparing pharmacies for this busy time. I have been fortunate enough to get an inside scoop on how much goes into preparing CPG pharmacies for flu season. I specifically got to see how involved this process is from a medical billing perspective. Working closely with Anna Dimak, one of the pharmacy residents, I was able to help the CPG pharmacies ensure that they have a successful and fully PAID season this year!
Here’s a look at how CPG pharmacies are getting ready for flu season and how I was able to help with this process.
Preparing Pharmacies for Flu Season
During flu season there is an increased demand for vaccines, medications, and healthcare advice. Pharmacies play a critical role in keeping the public healthy and informed, and preparation is key to managing the seasonal surge.
Pharmacies have become a major source of immunizations in this country. Since this is such a critical part of the services that CPG pharmacies provide during flu season it is important that the vaccine billing process runs smoothly.
Supporting the Vaccine Billing Process
One way I was able to help CPG pharmacies with the vaccine billing process was by providing them with a guide to help set up the EHR to accurately billing vaccines. Anna wrote the guide and I helped to send it to the CPG stores. I also made sure to provide the stores with a way to reach out to Anna if they needed any assistance with the setup process. Keeping track of which stores were able to complete the process versus who needed assistance was probably the toughest part of this process! One by one we were able to make sure that each pharmacy was set up properly. This will help prevent many billing issues during the flu season.
Ensuring Accurate Reimbursement
Another part of the preparation process for flu season was ensuring that CPG pharmacies were not underpaid for the vaccines they provided. Medicare Part B covers influenza and COVID-19 vaccines. In order to make sure that pharmacies were being reimbursed accurately for the administration of these vaccines I monitored the CMS (Centers for Medicare and Medicaid Services) website for updates on the pricing for these vaccines. These prices are updated annually right before flu season. It was critical that I watched the website very closely and updated CPG records as soon as the updates were provided. I also worked closely with the RCM department who was in charge of resolving any vaccine billing issues.
Medicare coverage can be complex, especially when it comes to billing for vaccines. COVID-19 and flu vaccines are always covered under Medicare Part B but if pharmacies do not provide the appropriate diagnosis codes and documentation they will not get reimbursed. I was able to observe how these issues were resolved so that the CPG pharmacies were not only compliant but also able to be reimbursed for vaccine administration.
Conclusion
Before this rotation I had no idea how much went into the vaccine billing process especially in preparation for flu season. Vaccines are a vital part of preventive healthcare, but billing for them can be more complex than it seems. Between product codes, administration codes, Medicare rules, and patient eligibility, getting vaccine billing right is critical for both compliance and reimbursement.
That is why I feel so fortunate that I was able to get a glimpse into this process and help CPG pharmacies prepare for this busy time!