2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Balance (PPO) Chapter 6: What you pay for your Part D prescription drugs 172 - The vaccine itself may be dispensed by a pharmacy or provided by the doctor’s office. 3. Who gives you the vaccine. - A pharmacist or another provider may give the vaccine in the pharmacy. Alternatively, a provider may give it in the doctor’s office. What you pay at the time you get the Part D vaccination can vary depending on the circumstances and what drug payment stage you are in. Below are 4 examples of ways you might get a Part D vaccine. Situation 1: You get your vaccination at the network pharmacy. (Whether you have this choice depends on where you live. Some states do not allow pharmacies to give certain vaccines.) Your cost-share may be lower when you use a network pharmacy. · For most adult Part D vaccines, you will pay nothing. · For other Part D vaccines, you will pay the pharmacy your coinsurance OR copayment for the vaccine itself which includes the cost of giving you the vaccine. · Our plan will pay the remainder of the costs. Situation 2: You get the Part D vaccination at your doctor’s office and they submit a claim on your behalf. · For most adult Part D vaccines, you will pay nothing. · For other Part D vaccines, you will pay your doctor your coinsurance OR copayment for the vaccine itself which includes the cost of giving you the vaccine. (Your doctor is not allowed to charge you more than your plan approved cost- share.) · Our plan will pay the remainder of the costs. Situation 3: You get the Part D vaccine at your doctor's office and ask them not to submit a claim on your behalf. (Your doctor is required to submit a claim unless you ask them not to.) · Before giving you the vaccine, your doctor must tell you what your out-of-pocket costs will be. · When you get the vaccine, you may have to pay for the entire cost of the vaccine itself and the cost for the provider to give it to you. · You can then ask our plan to pay our share of the cost by using the procedures that are described in Chapter 7. · For most adult Part D vaccines, you will be reimbursed the full amount you paid. For other Part D vaccines, you will be reimbursed the amount you paid less your normal coinsurance OR copayment for the vaccine (including administration), and less any difference between the amount the doctor charges and what we normally pay. (If you get “Extra Help,” we will reimburse you for this difference.) Situation 4: You buy the Part D vaccine itself at your pharmacy, and then take it to your doctor’s office where they give you the vaccine. · For most adult Part D vaccines, you will pay nothing for the vaccine itself.