Part D Vaccines
Beginning 1/1/2008, the administration of a Part D vaccine will be covered under Medicare Part D. Part D Plan Sponsors must cover the administration under their Part D Prescription Drug Benefit. SCAN will be supporting the new vaccine requirement in the following three ways:
- Member receives Part D vaccine drug and administration in the pharmacy where the member will pay their prescription drug co-pay or co-insurance.
- Member purchases Part D vaccine drug at the pharmacy, and goes to their physician to administer the vaccine. The member will pay their pharmacy co-pay at the pharmacy, and will pay-out-of-pocket for the administration fee. The member must then submit a paper claim to their pharmacy benefit for reimbursement.
- Member receives Part D vaccine drug and administration at their physician’s office, pays out-of-pocket, and submits a paper claim for reimbursement.
SCAN allows our members the choice to receive their vaccine at the pharmacy or the physician’s office. For our beneficiaries who choose to receive their Part D vaccine and/or the administration at the physician’s office, the beneficiary must have the following information to submit their manual claim for reimbursement:
- Date of Service
- Name of Member
- Member Pharmacy Benefit ID
- Name of Drug
- NDC of Drug
- Drug Administered (the drug and administration must be itemized)
- Days Supply
- Amount of Drug Cost
- Amount of Administration
Since both the drug cost and the administration of the Part D vaccine is covered under the Part D Prescription Drug Benefit, the member must submit their Part D vaccine claim to:
Express Scripts, Inc.
P.O. Box 66752
St. Louis, MO 63166-6752
ATTN: MED-D Accounts
As a result, DO NOT submit the claim to the SCAN Claims Department.
If you have any questions regarding the new 2008 Vaccine Administration policy, please contact your SCAN Provider Services Representative.