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  • Writer's pictureArwen Rasmussen

SeniorCare Coverage of Respiratory Syncytial Virus Vaccines

By the GWAAR Legal Services Team

You may have heard about the new respiratory syncytial virus (RSV) vaccines for older adults. RSV is a respiratory virus that typically causes cold-like symptoms in healthy adults and older children but can lead to more serious illness, like pneumonia, as well as hospitalizations and even death in very young children and older adults. The new vaccines will help protect older adults against severe illness from RSV. Talk to your healthcare provider about whether the RSV vaccine is right for you and any other vaccines you might need to help prevent illness.

As of September 5, 2023, SeniorCare covers RSV vaccines for SeniorCare members when the vaccine is administered in a pharmacy. Prior authorization is not required for these vaccines. If you have other health insurance, your pharmacy should bill that insurance first before submitting the claim to SeniorCare. If your pharmacy is unable to provide the RSV vaccine for you, pharmacy staff should refer you to another pharmacy that can provide the vaccine.

Please note that adult BadgerCare Plus and Medicaid members must receive the RSV vaccine at their doctor’s office. BadgerCare Plus and Medicaid will not cover the RSV vaccine if it is administered at a pharmacy.

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