Medicare Part D Vaccine Coverage

Payment for Part D covered vaccines and their administration are made solely by the participating Prescription Drug Plan. This includes all preventive vaccines not covered under Medicare Part B.

When providing a Part D covered vaccine to a Medicare patient, the physician should charge the patient for the vaccine and its administration. To facilitate the patient's reimbursement by his or her Part D plan, the physician's office should complete a CMS-1500 claim form for the vaccine and administration service and give it to the patient to file as an unassigned, out-of-network claim.

Alternatively, physicians may contract with eDispense Vaccine Manager when providing and administering Part D vaccines and bill the Part D plan using a web-based portal that verifies patient eligibility, vaccine coverage, as well as allowable and out-of-pocket costs. Physicians should note that enrolling in this program requires that the physician accept the allowed amount as full payment for the vaccine and its administration. This service is not endorsed or recommended by the AAFP. This specific product information is provided for member consideration as this appears to be the only such product currently available.

Some patients may also request a prescription for preventive vaccines and their administration to meet their Part D plan requirements to have this prescription filled by contracted providers (pharmacy and injection clinic).