Part D vaccines

Shingles (aka Zostavax, Shingrix) vaccine

As you get older, your risk for shingles and complications relating to it increases. Shingles is a rash made up of painful blisters that develop on one side of your body. If you’ve had chickenpox in the past, you’re at risk for shingles.

Tdap vaccine

A Tdap vaccine protects you against tetanus, diphtheria and pertussis (whooping cough). All three of these diseases can have serious long-term health impacts, which is why it’s important you get vaccinated. Health risks from contracting tetanus, diphtheria or pertussis can have a greater negative impact on older adults, so make sure to ask your provider if you’re up to date on your Tdap vaccine.

Where can I get a shingles and/or Tdap vaccine?

As a Priority Health Medicare member, you don’t need an order, referral or prescription from your doctor to get a shingles or Tdap vaccine. In fact, many pharmacies (including most major chains) can administer the vaccine and bill for it themselves, without any approvals needed.

Why should I go to the pharmacy?

We recommend going to a pharmacy because you may end up paying more out of pocket for a vaccine administered at your doctor’s office than at the pharmacy. If you get your vaccine at your doctor’s office, you may receive a bill for the full cost of the vaccine and the administration fee. This is because doctor’s offices are allowed to administer the vaccine, but they can’t bill Medicare Part D for it. If this happens to you, you should either pay the bill or make arrangements with the office, then submit the itemized bill you received from your doctor to Priority Health and we’ll manually bill Medicare Part D.

In some cases, your Tdap vaccine may be billed to Medicare Part B when administered at your doctor’s office, like if it’s used to treat potential exposure to the virus as the result of an injury.

If you need to be reimbursed for a vaccine you received from your doctor, fill out our Part D reimbursement form or call our customer service at 888.389.6648 (TTY 711) 8 a.m. to 8 p.m., seven days a week. Select the pharmacy option when prompted and one of our representatives will guide you through the process.

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