Hi-School Pharmacy Forms
Hi-School Pharmacy 2024-25 COVID Shot Prebook Form
| Manufacturer | Formulation/Storage | List Price Per Dose | Delivery Guarantees | Returns |
|---|---|---|---|---|
| Moderna | • Product is frozen - current approval for 30 days beyond-use date after refrigeration • Moderna’s COVID-19 vaccine has expiry dating of at least 10 months from date of manufacturer | $141.80 $129 for PEDS | Reasonable efforts through the season | • 20% returnability for Tier 1 • 100% returnability for Tiers 2-5 • Return process incorporates a returnability window at the end of the season for expired vaccine |
| Pfizer | • Expiration: 12+ PFS: 8 Months from start of manufacturing: Ultra-low temperature ("ULT"): 5y-11y SDV: 12 months 6m-4y MDV: 12 months • Storage and Use By Conditions: 5y-11y SDV and 6m-4y MDV stored at 2-8 degrees Celcius; 10 weeks expiry when stored as directed. 12+ PFS is 8 months expiry from start of manufacturing • Product shipping cold chain: Shipped to stores 2-8 degrees Celsius; 5y-11y and 6m-4y shipped to wholesalers at ULT | $136.75 | 1. 35% within the first 3 weeks of FDA approval or authorization for emergency use 2. 75% within the first 6 weeks of FDA approval or authorization for emergency use 3. 100% within the first 8 weeks of FDA approval or authorization for emergency use | • 30% Tier 1 and 2; 50% Tier 3 and 4; Tier 5 and beyond 100%; •100% returnability for pediatrics |
| Novavax | 10 pack of Prefilled Syringe •Storage and Handling – 2024-2025 will be same as last year’s formulation – The Prefilled Syringes will need to be stored in a refrigerator 2-8 degrees Celsius (36-46 Degrees Fahrenheit) • Expiry Date will be 9 months from manufacturing date. | $141.70 | Later August/early September | • 40% returnability by Banner • Doses can be returned upon expiration • Credits for returned, expired doses will be issued by the Authorized Distributor(s) from whom vaccine was purchased. Timing of credits is determined between Authorized Distributor(s) and purchaser. |
Adult-Based Product Proposals
| % of Business | Tier | Volume Start | Volume End | Moderna Spikeevax PFS | Pfizer Comirnaty NF PFS | Novavax PFS |
|---|---|---|---|---|---|---|
| <40% | 1A | 0 | 99,999 | $98.00 | $122.55 | $95.00 |
| <40% | 1B | 100,000 | 250,000 | $98.00 | $122.55 | $92.00 |
| <40% | 1C | 250,001 | 673,400 | $98.00 | $122.55 | $90.00 |
| 40% - 54% | 2 | 673,410 | 925,925 | $95.50 | $122.55 | $90.00 |
| 55% - 69% | 3 | 925,935 | 1,178,450 | $93.00 | $100.62 | $90.00 |
| 70% - 84% | 4 | 1,178,460 | 1,430,975 | $92.00 | $95.46 | $90.00 |
| 85% - 100% | 5 | 1,430,985 | 1,683,500 | $91.00 | $95.46 | $90.00 |
| >100% | 6 | 1,683,510+ | 1,683,510+ | $91.00 | $95.46 | $90.00 |
| 2023 Lowest Price | $104.57 | $101.91 | $95.55 |
Pediatric-Based Product Proposals
| % of Business | Tier | Volume Start | Volume End | Moderna PFS, 6 mo - 11 years | Pfizer MDV, 0 - 4 years | Pfizer SDV, 5 - 11 years |
|---|---|---|---|---|---|---|
| <40% | 1 | 0 | 2,800 | $89.15 | $55.78 | $74.69 |
| 40% - 54% | 2 | 2,810 | 3,850 | $86.88 | $55.78 | $74.69 |
| 55% - 69% | 3 | 3,860 | 4,900 | $84.60 | $54.63 | $73.15 |
| 70% - 84% | 4 | 4,910 | 5,950 | $83.70 | $53.48 | $71.61 |
| 85% - 100% | 5 | 5,960 | 7,000 | $82.78 | $53.48 | $71.61 |
| >100% | 6 | 7,001 + | 7,001 + | $82.78 | $53.48 | $71.61 |