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August 2019

We’ll add more vaccines to pharmacy benefit Aug. 1

Starting Aug. 1, 2019, eligible Blue Cross Blue Shield of Michigan and Blue Care Network commercial non-Medicare members will have coverage for additional vaccines under their pharmacy benefits plan. This allows participating pharmacies to bill through the pharmacy claims processing system.

We’ve added the following vaccines to the pharmacy benefit:

  • Tetanus, diphtheria
  • Polio
  • Measles, mumps, rubella
  • Meningococcal B
  • Varicella (chickenpox)

The program will cover the same vaccines that are offered under the Vaccine Affiliation program, which are currently billed under the medical benefit. Listed below are the vaccines and age requirements covered under the pharmacy benefits plan:

Vaccine Common name Age requirements
Influenza virus Flu None
Havrix® Hepatitis A None
Vaqta® Hepatitis A None
Twinrix® Hepatitis A and B None
Gardasil®9 HPV 9 to 27
Cervarix® HPV 9 to 27
Gardasil® HPV 9 to 27
M-M-R® II Measles, mumps, rubella None
Menveo® Meningitis None
Menactra® Meningitis None
Menomune® Meningitis None
Trumenba® Meningococcal B None
Bexsero® Meningococcal B None
Ipol® Polio None
Pneumovax 23 Pneumonia None
Pneumococcal
(PCV7)
Pneumonia None
Prevnar 13® Pneumonia 65 and older
Shingrix® Shingles 50 and older
Zostavax® Shingles 60 and older
Boostrix® Tetanus, diphtheria, whooping cough None
Adacel® Tetanus, diphtheria, whooping cough None
Tenivac® Tetanus, diphtheria None
Varivax® Varicella (chickenpox) None

Vaccines for Blue Cross members can be processed under both pharmacy benefits and medical plans, but only one plan can be billed per claim. Both plans require a qualified administrator at a Blue Cross‑participating pharmacy or medical office to give the vaccine.

Qualified pharmacists giving the vaccine can bill either the member’s pharmacy benefits plan or the member’s medical plan when the pharmacy participates in the medical Vaccine Affiliation Program.

Participating medical offices giving the vaccine should bill the member’s medical plan.

Most Blue Cross commercial members with prescription drug coverage are eligible. Most of the vaccines will be covered with no cost share to members if their benefits meet the coverage criteria.

Grandfathered and retiree opt-out groups won’t be part of this program. These groups will maintain their current vaccine coverage under their medical benefit.

Most Blue Cross and BCN members can search for a participating retail pharmacy by logging in to their member account at bcbsm.com. After logging in:

  • Hover the mouse over My Coverage in the blue bar at the top of the page.
  • Select Prescription from the drop-down menu.
  • Scroll down to Where to go for care and click on Find a pharmacy. The link will take you directly to Express Scripts®. You won’t have to log in again.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved.