Vaccine Coverage

Most commercially-available vaccines will be covered under your Part D pharmacy benefit. This also includes the administration fees associated with the vaccinations. Some other vaccines are covered as a Part B medical benefit, such as pneumococcal, rabies, and flu.

Many of these vaccines are available at no cost*, including the shingles vaccine (Zostavax). Bring your Zostavax prescription to a pharmacy in the MVP network to get the vaccine and ensure you pay the correct co-payment.

All Part D vaccines and vaccine administration fees must be billed through CVS/caremark, MVPs Pharmacy Benefit Manager (PBM). There is an on-line tool called TransactRX that your doctor can use to bill your claim directly to CVS/caremark. NOTE: Always ask your doctor to bill your Part D vaccine claims through TransactRX to ensure you pay the correct amount:

• If the Part D vaccine is in Tier 6 and is billed through TransactRX, or administered at a pharmacy, you will pay a $0 co-pay for the drug during the Initial Coverage and Coverage Gap Stages.* An office visit co-pay may apply.

• If the Part D vaccine is not in Tier 6 and is billed through TransactRX, you will pay your appropriate co-pay for the drugs tier. An office visit co-pay may apply.
• If your doctor is not familiar with the TransactRX tool, ask them to go to our website at www.mvphealthcare.com/provider or to call MVP Provider Services at 1-800-999-3920.

*Note: For Tier 6 vaccines, BasiCare and WellSelect members will pay a 51% co-insurance for generic drugs and 40% co-insurance for brand name drugs during the Coverage Gap Stage.

If you receive a Part D vaccine at the doctor's office, and your doctor does not bill your Part D vaccine using TransactRX, you will have to pay out-of-pocket for your vaccine and vaccine administration and submit a claim to CVS/caremark for reimbursement. MVP will reimburse vaccine claims up to an allowed amount. If your doctor chooses to charge more than the allowed amount for your vaccine and its administration, you will not be reimbursed for the full amount you paid.

Bring the Medicare Part D Prescription Drug Claim Form with you to your doctors office so they can help you fill it out at the time of service. This form must be submitted to CVS/caremark to obtain reimbursement for any Part D vaccine or vaccine administration fee. Please fill out the form completely and include a copy of your paid receipts to ensure proper and timely processing.

Flu and Pneumonia vaccines are both considered Part B benefits. If you choose to receive one of these vaccines in the pharmacy, ask them to bill your claims directly online to CVS/caremark. You will be charged a $0 co-pay. This applies to all MVP Medicare members at all in network pharmacies.

CVS/caremark Medicare Part D Prescription Drug Claim Form

Last updated: October 2016