The CDC’s Advisory Committee on Immunization Practices (ACIP) recommends vaccination with the 2-dose JYNNEOS vacine series for persons aged 18 years and older at risk for mpox. For a summary on mpox vaccine recommendations, click here.
Health insurance coverage policies for JYNNEOS include:
- Medicaid and Children’s Health Insurance Program (CHIP)
- Since JYNNEOS is included on the CDC/ACIP child and adolescent immunization schedule for people under age 19 and on the CDC/ACIP adult immunization schedule for people aged 19 and older, JYNNEOS vaccinations are covered for most Medicaid and CHIP beneficiaries aged 18 years and older as long as the administration of the vaccination adheres to the criteria in CDC/ACIP’s recommendation. Most people with full-benefit Medicaid or CHIP will not be subject to any cost sharing for JYNNEOS vaccination and its administration.
- The Medicaid Vaccine Toolkit provides information on vaccination coverage under Medicaid, CHIP, and the Basic Health Program.
- Medicare
- Part D: Since ACIP recommended the JYNNEOS vaccine in October 2023, people with Medicare prescription drug coverage receiving the vaccine in accordance with the ACIP recommendation pay nothing out of pocket for the vaccine.
- Part B:
- Medicare Part B will cover this vaccine if it is administered for purposes of treatment or post-exposure prophylaxis. There is no Medicare Part B coverage of JYNNEOS for preventive care, i.e., in the absence of a need for treatment due to a diagnosis, direct exposure, or other treatment needs.
- With respect to vaccines administered as treatment or post-exposure, people with Medicare are responsible for paying the Part B deductible and 20% coinsurance for both the vaccine and its administration.
- Private/Commercial Insurance
- JYNNEOS was reflected in the CDC Immunization Schedules on October 26, 2023. Therefore, plans and issuers must provide coverage starting with plan years beginning on or after October 26, 2024. In the individual market, coverage would be required beginning January 1, 2025.
- Most group health plans and health insurance issuers offering most group or individual health insurance coverage must provide coverage and must not impose any cost-sharing requirements (such as a copayment, coinsurance, or deductible) for vaccines for children, adolescents, and adults that have in effect a recommendation for routine use from ACIP with respect to the individual involved.
- New ACIP recommendations are required to be covered without cost-sharing starting with the plan year (in the individual market, policy year) that begins on or after the date that is one year after the date the recommendation is issued.
- Please see the December 2023 CMS Letter to Plans and Pharmacy Benefit Managers for additional information on coverage and reimbursement.
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