SeniorCare: Covered Drugs and Vaccines
SeniorCare is a program for Wisconsin residents who are 65 or older and need help paying for medicine. The program helps seniors pay for prescription drugs and vaccines.
For more information, call SeniorCare Customer Service at 800-657-2038 or visit the SeniorCare home page.
What is covered
SeniorCare covers:
Brand-name prescription drugs.
Generic prescription drugs.
Over-the-counter insulin.
Vaccines given at a pharmacy.
Getting drugs
There are some exceptions to brand-name and generic prescription drugs the program covers. Most drugs are only covered for a 34-day supply, although some maintenance drugs may be covered for a 100-day supply.
Learn about SeniorCare Covered Drugs, P-10084 (PDF)
Some prescription drugs require approval from SeniorCare to be covered. This is called prior authorization.
Your pharmacist may have to get prior authorization for some prescription drugs. Vaccines do not need prior authorization.
If the drug isn’t approved, it won’t be covered by SeniorCare. The cost also won’t count toward your spenddown or deductible (the amounts you have to reach in SeniorCare before you can pay a copay for covered prescription drugs).
If you travel outside of Wisconsin for an extended period, you need to ask your pharmacy to send your covered prescription drugs to you.
SeniorCare won’t cover prescription drugs filled by pharmacies that are outside of Wisconsin and don’t participate in the program except in these circumstances:
- An emergency happens, either from an accident or illness, that requires covered prescription drugs. This must occur in the United States, Canada, or Mexico, and the pharmacy must fill out all the necessary forms.
- Out-of-state pharmacies should call ForwardHealth Provider Services at 800-947-9627 to file a reimbursement claim.
- When a non-emergency prescription drug is granted prior authorization. This must occur in the United States, Canada, or Mexico.
Covered prescription drugs for members in participation levels 2B and 3 are limited to those whose manufacturer signed a rebate agreement with the state of Wisconsin. These agreements help fund the program because the manufacturer makes rebate payments to the state for drugs paid for by SeniorCare.
If the manufacturer of the prescription drug you take hasn’t signed a rebate agreement, there may be an alternative drug available. Your pharmacist may be able to help you get a drug from a manufacturer that has signed an agreement.
You can also call SeniorCare Customer Service at 800-657-2038 if you need help determining which drugs are covered by the program.
Getting vaccines
You can get certain vaccines at a pharmacy with no out-of-pocket costs. Depending on other coverage you have in addition to SeniorCare, you may need to get some vaccines at a pharmacy and others at your doctor’s office. Check with your plan on where you can get vaccines.
Learn how to Get the Vaccines You Need, P-03273 (available in multiple languages)
| Vaccine | Status | As Of |
|---|---|---|
| Anthrax | Covered | June 6, 2022 |
| Chickenpox (varicella) | Covered | June 6, 2022 |
| Chikungunya | Covered | February 1, 2024 |
| COVID-19 | Covered | June 6, 2022 |
| Diphtheria | Covered | June 6, 2022 |
| Flu (influenza) | Covered | June 6, 2022 |
| Hepatitis A | Covered | June 6, 2022 |
| Hepatitis B | Covered | June 6, 2022 |
| Japanese encephalitis | Covered | June 6, 2022 |
| Measles, mumps, and rubella (MMR) Coverage is limited to one dose for members born in 1957 or later | Covered | April 1, 2026 |
| Meningococcal | Covered | June 6, 2022 |
| Pneumococcal | Covered | June 6, 2022 |
| Poliovirus | Covered | June 6, 2022 |
| Rabies | Covered | June 6, 2022 |
| RSV (respiratory syncytial virus) | Covered | September 5, 2023 |
| Shingles (zoster) | Covered | June 6, 2022 |
| Smallpox/monkeypox (Jynneos) | Covered | April 1, 2024 |
| Tetanus | Covered | June 6, 2022 |
| Tick-borne encephalitis | Covered | June 6, 2022 |
| Typhoid | Covered | June 6, 2022 |
| Whooping cough (pertussis) | Covered | June 6, 2022 |
| Yellow fever | Covered | June 6, 2022 |
| Zaire ebolavirus | Covered | June 6, 2022 |
- Learn how to Get the Vaccines You Need, P-03273 (available in multiple languages)
This fact sheet lists the most common vaccines and how coverage works when you have SeniorCare, Medicare Part B, or Medicare Part D. - SeniorCare Vaccine Flyer, P-03523 (available in multiple languages)
This fact sheet answers common questions about SeniorCare-covered vaccines and how you can work with your pharmacy to get the vaccines you need. - Centers for Disease Control and Prevention (CDC) Immunization Schedules
The CDC provides recommended vaccine schedules for children from birth through age 18 and adults 19 and older.
What is not covered
SeniorCare does not cover:
- Brand-name drugs unless they’re determined medically necessary by your doctor.
- Drugs from manufacturers that haven’t signed a rebate agreement with the state.
- Drugs that are experimental or have a cosmetic, not medical, purpose.
- Prescription drugs that are denied prior authorization.
- Over-the-counter medicines like vitamins and aspirin, even if prescribed. An exception is insulin.
- Vaccines not given at a pharmacy.
Your pharmacy must let you know if a drug isn’t covered before filling your prescription. If you choose to buy a prescription drug that isn’t covered, you’ll have to pay the whole cost. It will not count toward your spenddown or deductible.
If your pharmacy tells you a drug isn’t covered, ask:
- Is it because it’s not covered by SeniorCare?
- Is it because the drug manufacturer didn’t sign a SeniorCare rebate agreement?
- Is it because you don’t have it available?
This will help you decide if you want to ask for an alternative drug or if SeniorCare won’t be able to cover it at all.
Participating pharmacies
All pharmacies certified to serve Wisconsin Medicaid members are also certified to serve SeniorCare members. More than 95% of all pharmacies in the state participate in Wisconsin Medicaid.
If you need help finding a participating pharmacy, call SeniorCare Customer Service at 800-657-2038.
SeniorCare only covers services performed by a participating pharmacy. The pharmacy is responsible for submitting claims to the program. SeniorCare doesn’t pay members directly for services received. For that reason, you shouldn’t send bills or prescription receipts.
More resources
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