We reimburse contracted providers for covered immunization services, including necessary supplies.
Members 18 years of age and older with pharmacy benefits can go to a participating Express Scripts 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, reimbursement includes the vaccine ingredient cost, dispensing fee, and administration. This means that Medicare members can only be charged one pharmacy copayment for both the vaccine and for its administration.
|Part B Covers These Vaccines:||Part D Covers These Vaccines:|
Those 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.