Potential Complexities in Billing for Vaccine Services Under Medicare

As more and more community pharmacies look toward vaccine services to grow their revenue sustainability, apparent billing complexities arise for patients covered under either Medicare Part B or Part D. Traditionally, vaccine services are billed under both parts of Medicare plans.¹

“The best system process is to make sure that it's transparent, obviously, to the patient, but also from a pharmacy perspective,” Rick Sage, executive vice president of innovation and standards with the National Council for Prescription Drug Programs (NCPDP), told Drug Topics. “[Pharmacies should] not spend more time trying to create the bill to get reimbursed than it's actually being reimbursed for the service that they're providing.”

With pharmacies’ greater focus on their expertise in vaccines, as well as Medicare drug price negotiations taking effect in 2026, the current landscape for pharmacist-administered vaccines is both exciting yet uncharted. As pharmacies grow their services and continue to navigate billing challenges, they will gradually understand the nuances between Medicare Part B or Part D services and medications.

In his role at NCPDP, Sage and his team work to improve the delivery of health care across the US while introducing innovative standards and solutions to tackle pharmacy’s greatest challenges. The complexities gradually arising within the Medicare Drug Price Negotiation Program are nothing new to many experts within pharmacy, especially Sage.

Learn from his insights into why this is a unique time for vaccine services in retail and independent pharmacy. Also, stay tuned for more from our interview with Sage, who will be featured on the next episode of Over the Counter powered by Drug Topics.

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REFERENCE

Which vaccines does Medicare cover? UnitedHealthcare. Accessed November 19, 2025. https://www.uhc.com/news-articles/medicare-articles/which-vaccines-does-medicare-cover