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MVP Medicare Customer Care Center
Monday - Friday
8 am - 8 pm (EST)
From Oct. 1 - Feb 14, call seven days a week, 8 am to 8 pm
MVP Medicare Product Advisors
Monday - Friday, 8 am - 8 pm (EST)
220 Alexander St.
Rochester, NY 14607
24/7 Nurse Advice Line
Request a Coverage Determination or Formulary Exception
Phone: 855 853-4852
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:
*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.
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.
Last updated: October 2016