​​Vaccine coverage for influenza, pneumonia, and shingles​

November 12, 2021

We are in the middle of the flu and pneumonia seasons. These, along with shingles, are three common ailments that impact our members, your patients.

Independence covers these vaccines for all members.

Commercial members can receive the vaccines through their medical or pharmacy* benefit.

Medicare Advantage members can receive the influenza and pneumonia vaccines through their medical (Part B) benefit. The vaccines must be administered by a provider who can bill it as a medical claim, which may include some pharmacies. Only Medicare Advantage members with a Part D (prescription drug) plan can receive the shingles vaccine at the pharmacy through their pharmacy benefit. You can read more about Part D vaccines in the Pharmacy sectio​n of the Provider Manual for Participating Professional Providers.

Use PEAR Practice Management to confirm benefits and coverage.

*Coverage under the pharmacy benefit began on September 1, 2021, for those who are part of a fully insured commercial group. Members who are part of a self-funded group must choose this coverage.