Pharmacists must be sure to enter the proper billing unit when dispensing vaccines. The correct billed quantity for these products should be based on the number of milliliters, but Express Scripts is aware that some pharmacies are submitting the quantity as the number of vaccines rather than the volume of product contained in each vaccine. As a result, claims are being billed for significantly higher amounts than the actual quantity of product dispensed.

The polio vaccine, or IPOL, and standard flu vaccines are prime examples. These vaccines are dispensed at 0.5mL for one dose. A quantity dispensed of 0.5 should be submitted on the claim to indicate the actual volume of product dispensed, rather than the number one (1) to indicate the number of vaccines dispensed

*Please see attached PDF for more information.

As part of our initiative to increase the available vaccines for participating providers in the Vaccine and Immunization and Injection2 Network, we have added Prevnar13 to the Flu Season Communication 2014-2015 roster.

This vaccine is available for administration to eligible plan members under the OptumRx Program as of May 1, 2015.

FFF Enterprises has made its 2015-2016 influenza vaccine order form available.

Effective February 1, 2015, IlliniCare Health will begin covering several new vaccinations. These vaccinations must be administered according to state pharmacy regulations and appropriate dosage restrictions. You are obligated to report the administration of each vaccination within 30 days to the member’s primary healthcare provider*.