We’ll add more vaccines to pharmacy benefit for commercial members

Starting Dec. 1, 2020, eligible Blue Cross Blue Shield of Michigan and Blue Care Network 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.

The following hepatitis B vaccines are being added to the pharmacy benefit:

• Energix-B
• Heplisav-B
• Recombivax HB

Listed below are the vaccines (and age requirements) that will be covered under the pharmacy benefits plan:

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 may 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 members with commercial prescription drug coverage are eligible for vaccines 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.

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, they would:

• Hover the mouse over My Coverage in the blue bar at the top of the page.
• Select Prescription from the drop-down menu.