Requires health insurance carriers to reimburse health care providers for vaccines at rate no less than CDC cost per dose rate.

2026-2027 Regular Session Introduced by Vin Gopal and 2 co-sponsors

Insurers must reimburse vaccine providers at least the CDC cost-per-dose price for each vaccine, based on the rate in effect when administered.

Referred to Senate Budget and Appropriations Committee

Purpose and intent

The bill requires health insurance carriers operating in New Jersey to reimburse health care providers for vaccines at a rate no less than the CDC’s cost-per-dose price for the specific vaccine, as listed on the CDC vaccine price list.

The CDC cost-per-dose rate used for reimbursement is the rate in effect on the date the vaccine was administered by the provider.

The overall aim is to ensure vaccine-related reimbursements meet or exceed CDC-established pricing benchmarks.

Key provisions

Reimbursement minimum: A health insurance carrier must reimburse a provider for a vaccine at a rate that is at least the CDC cost-per-dose rate for that vaccine.

CDC price list reference: The applicable rate is drawn from the CDC vaccine price list, specifically the cost-per-dose rate for the vaccine in question.

Timing of rate: The reimbursement rate to be used is the CDC rate in effect on the date the vaccine was provided by the health care provider.

Applicability: Applies to a broad category of insurers in New Jersey, including:

Traditional insurance companies
Health, hospital, and medical service corporations
Health maintenance organizations (HMOs)

Effective date and applicability: The act takes effect on the first day of the 13th month following enactment and applies to contracts entered into or renewed after that date.

Who/what is affected

Health care providers who administer vaccines (e.g., clinics, physicians, pharmacies, and other vaccine providers).

Health insurance carriers operating in New Jersey (including various forms of insurers and managed care organizations).

Vaccine administration and reimbursement processes linked to private payers and plans subject to the bill’s requirements.

Procedural and timeline aspects

Introduction: January 13, 2026; referred to Senate Commerce Committee.

Committee actions: Reported from the Senate Committee and sent to the Budget and Appropriations Committee on March 16, 2026.

Enactment timing: The act would become effective on the first day of the 13th month after enactment, with the requirement applying to contracts entered into or renewed after that date.

Legislative language basis: The bill supplements existing New Jersey law (P.L.1997, c.192; C.26:2S-1 et seq.) governing health insurance practices.

Additional notes

The bill relies on the CDC vaccine price list as the benchmark for reimbursement rates, tying private payer reimbursements to federal pricing data.

No specific dollar amounts are set in the bill; the reimbursement floor is driven by the CDC cost-per-dose rates, which vary by vaccine and are updated by CDC.