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HomePrevnar 20®Prevnar 20® (Pneumococcal 20-valent Conjugate Vaccine)Broad pneumococcal defenseMOABurden of diseaseIPDCAPPatient profilesPatient profilesRoger, 59: DiabetesSean, 35: AsthmaWilliam, 55: COPDJanet, 58: Chronic Heart DiseaseSophia, 71: Healthy ≥65; Previously VaccinatedMary, 65: Healthy ≥65; Unknown Vaccination HistoryACIP recommendationsACIP recommendationsACIP recommendationsClinical studies

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Prescribing InformationIndicationsPatient SiteOrder Prevnar 20®
Access & supportPrevnar 20® (Pneumococcal 20-valent Conjugate Vaccine) is covered by Medicare and commercial health plans

Prevnar 20 is covered by Medicare

Medicare fee for service
  • Medicare began covering Prevnar 20 on October 1, 20211
  • Pneumococcal vaccines covered under Part B are available to Medicare beneficiaries at $0 out of pocket2
Prevnar 20 is covered for the following patient types3
Medicare beneficiaries who are pneumococcal vaccine-naïve
  Medicare beneficiaries are eligible to receive a different, second pneumococcal vaccine 1 year after the first vaccine was administered  Medicare Advantage (MA)
  • Represents approximately 43% of Medicare enrollees5​​​​​​​
  • MA plans are required to cover all services covered by Medicare fee for service6
    • $0 cost share applies when vaccine is administered by an in-network provider2​​​​​​

Prevnar 20 is covered by commercial plans

Under the Affordable Care Act, non-grandfathered commercial health plans cover Advisory Committee on Immunization Practices (ACIP) recommended vaccines without requiring a copayment or coinsurance7 $0 cost share applies when vaccine is administered by an in-network provider8
As of October 20, 2021, ACIP provisionally recommends Prevnar 20 in adults age 65 years or older and those age 19-64 with certain underlying medical conditions or other risk factors* who have not previously received a pneumococcal conjugate vaccine or whose previous vaccination history is unknown9 As of January 28, 2022, ACIP recommendations are published in the Morbidity and Mortality Weekly Report (MMWR)10

As of October 11, 2022, 95% of commercial lives have coverage for Prevnar 2011

Pfizer Vaccines Reimbursement Support Services can assist with benefit investigations
Phone: (866) 744-3198, Monday to Friday, 8:00 am – 8:00 pm Eastern Time

CSF=cerebrospinal fluid.Alcoholism, chronic heart/liver/lung disease, cigarette smoking, diabetes, chronic renal failure,† nephrotic syndrome,† iatrogenic immunosuppression,† generalized malignancy,† human immunodeficiency virus,† Hodgkin disease,† leukemia,† lymphoma,† multiple myeloma,† solid organ transplant,† congenital or acquired asplenia,† sickle cell disease or other hemoglobinopathies,† CSF leak, cochlear implant, or congenital or acquired immunodeficiencies.10†Immunocompromising conditions.References:Centers for Medicare & Medicaid Services. MLNConnects. October 14, 2021. Accessed October 20, 2021. https://www.cms.gov/files/document/2021-10-14-mlnc.pdf Medicare.gov. Pneumococcal shots. Accessed September 30, 2021. https://www.medicare.gov/coverage/pneumococcal-shots Department of Health & Human Services (DHHS). CMS Manual System. Pub 100-02 Medicare Benefit Policy. Transmittal 202. http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R202BP.pdf Prevnar 20® (Pneumococcal 20-valent Conjugate Vaccine) Prescribing Information, Wyeth Pharmaceuticals LLC, 2022. Data.cms.gov. Monthly Medicare Enrollment Dashboard. August 2021. Accessed October 4, 2021. https://data.cms.gov/summary-statistics-on-beneficiary-enrollment/medicare-and-medicaid-reports/medicare-monthly-enrollment-dashboard/data/august-2021 Medicare.gov. Medicare Advantage plans cover all Medicare services. Accessed September 30, 2021. https://www.medicare.gov/what-medicare-covers/what-medicare-health-plans-cover/medicare-advantage-plans-cover-all-medicare-services Schwartz K, Freed M, Cubanski J, et al. Vaccine coverage, pricing, and reimbursement in the U.S. Kaiser Family Foundation (KFF). November 18, 2020. Accessed September 30, 2021. https://www.kff.org/report-section/vaccine-coverage-pricing-and-reimbursement-in-the-u-s-issue-brief Centers for Disease Control and Prevention (CDC). Resources for adult vaccination insurance and payment. May 2, 2016. Accessed September 30, 2021. https://www.cdc.gov/vaccines/hcp/adults/for-practice/insurance-payment.html Kobayashi M. Considerations for age-based and risk-based use of PCV15 and PCV20 among U.S. adults and proposed policy options. Presented at: Advisory Committee on Immunization Practices; October 20, 2021. Accessed October 20, 2021. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-10-20-21/02-Pneumococcal-Kobayashi-508.pdf Kobayashi M, Farrar JL, Gierke R, et al. Use of 15-valent pneumococcal conjugate vaccine and 20-valent pneumococcal conjugate vaccine among U.S. adults: updated recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(4):109-117. Data on file. Pfizer Inc.
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INDICATIONS AND SELECT SAFETY INFORMATION
  • Prevnar 20® is indicated for active immunization for the prevention of invasive disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F in individuals 6 weeks of age and older
  • Prevnar 20® is indicated for active immunization for the prevention of pneumonia caused by S. pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F in individuals 18 years of age and older
  • The indication of Prevnar 20® for the prevention of pneumonia caused by S. pneumoniae serotypes 8, 10A, 11A, 12F, 15B, 22F, and 33F in individuals 18 years of age and older is approved under accelerated approval based on immune responses as measured by opsonophagocytic activity (OPA) assay. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial
  • Prevnar 13® is indicated for active immunization for the prevention of pneumonia and invasive disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F in adults 18 years of age and older
Prevnar 13® Limitations of Use: Prevnar 13® will only help protect against S. pneumoniae serotypes in the vaccine

SELECT SAFETY INFORMATION
 
  • Do not administer Prevnar 20® or Prevnar 13® to individuals with severe allergic reaction (eg, anaphylaxis) to any component of Prevnar 20® or Prevnar 13® or to diphtheria toxoid
  • Safety and immunogenicity data on Prevnar 20® are not available for individuals in immunocompromised groups and vaccination should be considered on an individual basis. Based on experience with pneumococcal vaccines, individuals with altered immunocompetence may have reduced immune responses to Prevnar 20®
Important Safety Information
  • Do not administer Prevnar 20® or Prevnar 13® to individuals with severe allergic reaction (eg, anaphylaxis) to any component of Prevnar 20® or Prevnar 13® or to diphtheria toxoid
  • Safety and immunogenicity data on Prevnar 20® are not available for individuals in immunocompromised groups and vaccination should be considered on an individual basis. Based on experience with pneumococcal vaccines, individuals with altered immunocompetence may have reduced immune responses to Prevnar 20®
  • Immunocompromised individuals or individuals with impaired immune responsiveness due to the use of immunosuppressive therapy may have reduced antibody response to Prevnar 13®
  • For Prevnar 20®, in individuals 18 years of age and older, the most commonly reported solicited adverse reactions (>10%) were pain at the injection site, muscle pain, fatigue, headache, and arthralgia. Additionally, injection site swelling was also reported (>10%) in individuals 18 through 59 years of age  
  • For Prevnar 13®, in adults 18 years of age and older, the most commonly reported solicited adverse reactions (>5%) were pain, redness, and swelling at the injection site, limitation of arm movement, fatigue, headache, muscle pain, joint pain, decreased appetite, vomiting, fever, chills, and rash
Patients should always ask their healthcare providers for medical advice about adverse events. 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 http://www.vaers.hhs.gov or call 1-800-822-7967.

Please click for Prevnar 20® Full Prescribing Information.

Please click for Prevnar 13® Full Prescribing Information.Indications
  • Prevnar 20® is indicated for active immunization for the prevention of invasive disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F in individuals 6 weeks of age and older 
  • Prevnar 20® is indicated for active immunization for the prevention of pneumonia caused by S. pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F in individuals 18 years of age and older
  • The indication of Prevnar 20® for the prevention of pneumonia caused by S. pneumoniae serotypes 8, 10A, 11A, 12F, 15B, 22F, and 33F in individuals 18 years of age and older is approved under accelerated approval based on immune responses as measured by opsonophagocytic activity (OPA) assay. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial
  • Prevnar 13® is indicated for active immunization for the prevention of pneumonia and invasive disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F in adults 18 years of age and older
Prevnar 13® Limitations of Use: Prevnar 13® will only help protect against S. pneumoniae serotypes in the vaccine