Blue Cross members can get vaccines at participating pharmacies starting Oct. 1.

Starting Oct. 1, 2016, Blue Cross Blue Shield of Michigan (non-Medicare) commercial members will have vaccine coverage under their pharmacy benefits plan. This will allow select vaccines to be given at Blue Cross participating pharmacies and billed through the pharmacy claims processing system. This program will cover the same vaccines listed in the Vaccine Affiliation Program.

Below is a list of frequently asked questions.

Can I process Blue Cross members’ vaccines under both their prescription and medical plans?

Yes, but only bill one plan per claim. Both plans require a qualified administrator at a Blue Cross participating pharmacy or medical office give the vaccine.

• Qualified pharmacists giving the vaccine can bill the member’s pharmacy benefits plan or medical plan.
• Participating medical offices giving the vaccine should bill the member’s medical plan.

Note: All medical and pharmacy claims are subject to monitoring.

Who can receive vaccinations at participating retail pharmacies using their prescription drug plan?

Most Blue Cross commercial (non-Medicare) members with prescription drug coverage are eligible. The vaccine will be covered with no cost share to members if their benefits meet the coverage criteria. Note: Not all members are eligible so you’ll need to check the members’ benefits.

• Check to make sure the vaccine is payable under the member’s medical plan or pharmacy benefits
• Check the age requirements for the vaccine. If a member doesn’t meet the age requirement the claim won’t be covered.

Sample Blue Cross membership cards with the pharmacy benefits plan:

MOS     Rx Grp: BCBSMRX1	NASCO     Rx Grp: BCBSMAN

What is the message for rejected pharmacy claims?

The message for rejected pharmacy claims is 70 for Product-Service Not Covered if there is no age requirement.

If the age requirement is not met, the message is 60 for Product-Service Not Covered for patient age.

What vaccines can be processed under the Blue Cross prescription drug plan?

Listed below are the vaccines and age requirements covered under the pharmacy benefits plan.

Note: Members’ coverage for vaccines may vary, so check their benefits to make sure which vaccines are covered.

Can a member get a vaccine before Oct. 1, 2016?

Yes, if the member has vaccine coverage under his or her medical benefits.

How should pharmacy vaccines be billed for Blue Cross commercial members?

The vaccines are billed like any other pharmacy claim:

• Bill the metric quantity administered (for example, bill 0.5 ml; don’t bill quantity of 1)
• Follow state regulations when administering vaccines
• Use the National Council for Prescription Drug Programs format to submit the vaccines

Vaccines must be prescribed by a licensed prescriber or doctor to be covered. Standing physician orders are also acceptable. Pharmacies should refer to Schedule B of the Restated and Amended Preferred Rx Participation Agreement and Traditional Rx Participation Agreement we sent you.

All standard claims should include the following:

Does this new process pertain to Blue Care Network or Medicare Part D members?

No. You should continue to process BCN and Medicare Part D members’ vaccine claims as usual.

What should the pharmacy do if it has Blue Cross vaccine billing issues?
If you have any questions or billing issues, call Express Scripts^® Pharmacy Technical Help Desk at 1-800-922-1557, 24 hours a day, seven days a week.