Effective for dates of service on and after September 5, 2023, SeniorCare covers respiratory syncytial virus (RSV) vaccines for SeniorCare members when the vaccine is administered in a pharmacy. Prior authorization is not required for RSV vaccines.
As a reminder, vaccines are covered by the SeniorCare program with no out-of-pocket expenses to the members. SeniorCare is the payer of last resort. Pharmacy providers should bill members’ other health insurance and Medicare plans before submitting claims to ForwardHealth.
Pharmacy providers who are unable to provide a requested vaccine must refer the SeniorCare member to another pharmacy provider. Pharmacy providers may not charge SeniorCare members for any covered vaccine.
Note: Coverage for RSV vaccines for adult BadgerCare Plus and Medicaid members is not available through fee-for-service when administered by a pharmacy provider. Coverage for RSV vaccines for adult BadgerCare Plus and Medicaid members is available through their medical benefit. Pharmacy providers should instruct these members to contact their medical provider to receive RSV vaccines at their doctor’s office.
Pharmacy providers are required to enter administered vaccines for all members into the Wisconsin Immunization Registry (WIR) within seven days of administering the vaccine. Providers are required to follow all state and federal reporting requirements when they administer vaccines.
For more information on vaccines, pharmacies should view the Vaccines topic (#12457) of the ForwardHealth Online Handbook.
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