Department of Health Services: Wisconsin SeniorCare program to cover vaccines provided at pharmacies

Governor Tony Evers and the Wisconsin Department of Health Services (DHS) announce that the Wisconsin SeniorCare program has received approval from the Centers for Medicare & Medicaid Services (CMS) to cover certain vaccines members receive at pharmacies. Vaccines covered include those that protect against shingles, tetanus, meningitis, and hepatitis A and B. These vaccines are recommended by the Advisory Committee on Immunization Practices.(link is external) (ACIP) for adults aged 65 and over.

“Access to healthcare shouldn’t be just for the healthy and wealthy, and that’s why we’ve worked hard to extend coverage to the elderly and elderly by fully funding SeniorCare, lobbying for the expansion of BadgerCare and by proposing comprehensive legislation to reduce prescription drug prices,” Governor Evers said. “Requiring SeniorCare to cover vaccines is another important step in ensuring seniors can get the care they need and stay healthy.”

Members with other insurance that covers vaccines, such as Medicare Part D, must use their primary coverage first, and then SeniorCare will cover any copayments or deductibles when vaccines are delivered to a pharmacy. SeniorCare members with Medicare Part B coverage must use Medicare Part B coverage to get certain vaccines, those that protect against the flu, pneumonia, or COVID-19. Members should check their plans and work with their providers to find where they can get vaccines as part of their coverage.

SeniorCare can only pay for vaccines supplied and invoiced in pharmacies. To receive a SeniorCare-covered vaccine at a pharmacy, members should call ahead for information on available vaccines and how to schedule an appointment. They must bring their SeniorCare card with them when they leave. Members will be able to take advantage of this benefit later this month after receiving notice in the mail.

“Vaccines provide essential protection against disease for people of all ages,” said Karen Timberlake, DHS secretary designate. “Being able to help Wisconsin seniors get many of the vaccines they need at their local pharmacies extends the success we’ve had working with our pharmaceutical partners to make vaccines more accessible in Wisconsin communities.” By expanding the vaccine coverage of the SeniorCare program, we hope to see an increase in vaccination rates for preventable diseases.

Established in 2002, SeniorCare is a prescription drug assistance program for Wisconsin residents age 65 or older. In April 2019, Governor Evers announced(link is external) that CMS had approved a 10-year extension of the waiver that allows the state to offer the program. The governor first proposed requiring SeniorCare to cover vaccines in a package of COVID-19 relief laws he announced(link is external) in April 2020, and the legislature later included the provision in Wisconsin Law 185 of 2019(link is external). Currently, more than 100,000 seniors are enrolled in the program.

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