Mercy Health Plans (MHP) covers
the Zostavax vaccine for all members age 60 years and
older. Reimbursement depends upon the coverage plan
of the member.
For Commercial Members:
Zostavax (CPT 90736) and its administration
are covered when billed under the member’s medical benefit.
Zostavax is not covered under
the pharmacy benefit for commercial or non-Medicare
members.
However, if a member does pay cash
for the vaccination at the pharmacy and submits the
receipt to MHP’s Pharmacy Department, the member will
be reimbursed.
You may order Zostavax from CuraScript
Specialty Pharmacy and request its shipment to your
office for administration by completing the CuraScript
Enrollment form at
mercyhealthplans.com or contacting CuraScript at
1-888-773-7376.CuraScript will bill MHP under the member’s
medical benefit.
For Medicare Members (Mercy
MedicareADVANTAGE)
Zostavax and its administration are
covered under the Part D pharmacy benefit for Medicare
members, as required by CMS.
Claims for Zostavax and its administration
must be processed through Caremark, MHP’s pharmacy benefit
manager, to apply the associated costs appropriately
(TrOOP and member co-payment).
MHP offers three options for obtaining
Zostavax for our MedicareADVANTAGE members:
Submit a paper claim (CMS1500) for
Zostavax and administration to MHP’s Pharmacy Department*
for processing at Caremark under the member’s Part D
benefit. Caremark will reimburse you at the same rate
MHP reimburses a Part D network pharmacy, minus the
member’s Part D co-payment. Caremark will send you a
remittance advice that includes the co-payment amount
collected from the member.
Write a prescription for Zostavax
to be filled at a network pharmacy. The member may bring
the vaccine or it can be shipped to your office for
administration. The pharmacy will bill MHP for the vaccine
under the member’s Part D benefit. Your office may submit
a paper claim (CMS1500) to MHP* for the administration.
Write a prescription for Zostavax
to be filled and administered at a network pharmacy
(dependent upon state regulations). The pharmacy will
bill MHP for the vaccine and administration under the
member’s Part D benefit.
*For this claim only:
Mercy Health Plans
ATTN: Pharmacy Dept.
14528 S. Outer Forty Rd.
Chesterfield, MO 63017
Contact your provider relations representative
for additional information.