We reimburse contracted providers for covered immunization services, including necessary supplies.
You can help members save money
How can you help?
Encourage Medicare members with prescription drug benefits to receive their Part D vaccines at a retail pharmacy and not from a medical provider.
(Note: Medical clinics inside pharmacies, such as MinuteClinic, are considered medical providers, NOT pharmacy providers.)
Why does this save them money?
Part D vaccines are part of the member’s pharmacy benefit—not their medical benefit.
Members who receive Part D vaccines from a medical provider must submit a claim to us to be reimbursed. When a member follows this process, they are reimbursed according to their provider’s allowed amount for the administration of the drug, and this may not cover the total cost to the member.
When a Part D vaccine is administered by a pharmacy, administration costs are covered.
Members 18 years of age and older with pharmacy benefits can go to an in-network retail pharmacy to get the vaccinations listed below. These are covered with no cost share to the member and a prescription is not required.
The pharmacist must be registered and licensed to administer these vaccines:
This benefit applies to members who have pharmacy benefits and participate in these plans:
Some vaccines administered to Medicare beneficiaries are covered under Part B; most others are covered under Part D (see chart below for examples).
For vaccines administered under Part D, all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) will be $0 copay for Medicare members.
|Part B covers these vaccines||Part D covers these vaccines|
Vaccines that are not covered by Part B, such as:
You have three options for submitting claims for vaccines that you administer to Medicare Advantage members with prescription drug benefits (Part D):
Not enrolled in TransactRx? You'll need to complete a one-time-only registration process and sign an agreement with POC.