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.
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