Supplies – Medical Pharmacy

Supplies associated with vaccine administration

When a vaccine is administered at the pharmacy, routine supplies associated with the administration of a vaccine (e.g., syringe, gauze, tape) are included in the fee paid for vaccine administration and are not separately paid. Participating pharmacies may not bill members for the supplies.

Example (vaccine dispensed and administered at the pharmacy)

Supplies associated with self-administered injectables (non-vaccines)

HMSA’s Private Business Plans

Coverage

Supplies required for the self administration of injectable drugs for members of HMSA’s private business plans (e.g., PPO, HMO), may be billed separately when they are dispensed in quantity for members with chronic conditions requiring daily injections for an extended period of time. The supplies may be billed using the appropriate HCPCS code (e.g., A4211).

However, if one dose of an injectable drug is dispensed, and the drug does not come in a kit containing the necessary supplies (e.g., a pre-filled syringe or pen), supplies should be included with the order and should not be separately billed to HMSA. Participating pharmacies may not bill members for the supplies.

To check plan benefits for supplies, please refer to the member’s benefit information in the HHIN+ Documents & Information Network (HHIN+). In addition to any copayment or coinsurance amounts designated by the member’s plan, medical supplies may be subject to an annual deductible. See HMSA Plan Deductibles.

Medicare Advantage (Part B)

Coverage

HMSA considers the cost of supplies required by a Medicare Advantage (Part B) member to self-administer a drug to be included in the eligible charge for the drug. The supplies should not be separately billed to HMSA, and may not be billed to members.

Revision History