How to Request Coverage for Vaccines

Certain vaccines are covered under your Medicare Part D prescription drug plan. See your Formulary for details.  As of January 1, 2008, the administration fee for these vaccines is also covered under Medicare Part D.

Claims for vaccines and their administration are handled differently from other types of claims. Please follow the instructions below carefully to avoid delays.

If you get your vaccines from your doctor (or other prescriber):

Step 1:  Pay your doctor (or other prescriber) for the vaccine and its administration (injection).

Step 2:  Request a receipt, and make sure it includes:

• • • • Name of vaccine
      • Drug quantity
      • Days' supply
      • NDC Number
      • The amount charged for the vaccine itself
      • The amount charged for administration (injection) of the vaccine

Step 3: Submit a Vaccine and Administration (Injection) Claim Form, along with the receipt, to Medco for reimbursement. Be sure to:

• • • • Fill out the "Prescribing Physician Information" section.
      • Check off the box next to "Both the vaccine and the administration (injection) of the vaccine in the "Claim Information" section.
      • Provide vaccine information in the "Vaccine Rx Information" section.
      • Submit a separate form for each vaccine you receive.

If you get your vaccine from a retail pharmacy and have it administered (injected) by your doctor (or other prescriber):

Step 1:  Take the vaccine to your doctor (or other prescriber) to administer (inject).

Step 2:  Pay your doctor for administering (injecting) the vaccine and request a receipt.

Step 3:  Submit a Vaccine and Administration (Injection) Claim Form along with the receipt, to Medco for reimbursement. Be sure to:

• • • • Fill out the "Prescribing Physician Information" section.
      • Check off the box next to "Administration (injection) of the vaccine" In the "Claim Information" section.
      • Provide vaccine information in the "Vaccine Rx Information" section (leave the "Vaccine Charge" column blank).

If you get your vaccine from a retail pharmacy and the pharmacist is certified to administer (inject) vaccines:

Step 1:  Ask your doctor (or other prescriber) to write a prescription for the vaccine.

Step 2:  Take the prescription to the retail pharmacy. Be sure that it participates in your plan's network, and remember to present your Member ID card as well.

Step 3:  Pay the appropriate co-payment or coinsurance. You do not need to fill out any claim forms.