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August 2022

Blue Cross, BCN covering additional vaccine

To increase access to vaccines and decrease the risk of vaccine-preventable disease outbreaks, Blue Cross Blue Shield of Michigan and Blue Care Network will add the following vaccine to our list of vaccines covered under the pharmacy benefit:

Vaccine Common name and abbreviation Age requirement Effective date
PreHevbrio™ Hepatitis B (HepB) None June 1, 2022

The following table lists all the vaccines that are covered under eligible members’ prescription drug plans. Most Blue Cross and BCN commercial (non-Medicare) members with prescription drug coverage are eligible. If a member meets the coverage criteria, the vaccine is covered with no cost sharing.

Vaccine Common name and abbreviation Age requirement
Dengvaxia Dengue vaccine None
Daptacel® Diphtheria, tetanus, and acellular pertussis vaccine (DTaP) None
Infanrix® Diphtheria, tetanus, and acellular pertussis vaccine (DTaP) None
Diphtheria and Tetanus Toxoids Diphtheria, tetanus vaccine (DT) None
Kinrix® DTaP and inactivated poliovirus vaccine (DTaP-IPV) None
Quadracel® DTaP and inactivated poliovirus vaccine (DTaP-IPV) None
Pediarix® DTaP, hepatitis B, and inactivated poliovirus vaccine (DTaP-HepB-IPV) None
Pentacel® DTaP, inactivated poliovirus, and Haemophilus influenzae type b vaccine (DTaP-IPV/Hib) None
Vaxelis DTaP, inactivated poliovirus, Haemophilus influenzae type b, and hepatitis B vaccine (DTaP-IPV-Hib-HepB) None
ActHIB® Haemophilus influenzae type b vaccine (Hib) None
Hiberix® Haemophilus influenzae type b vaccine (Hib) None
PedvaxHIB® Haemophilus influenzae type b vaccine (Hib) None
Havrix® Hepatitis A (HepA) None
Vaqta® Hepatitis A (HepA) None
Engerix-B® Hepatitis B (HepB) None
Heplisav-B® Hepatitis B (HepB) None
PreHevbrio™ Hepatitis B (HepB) None
Recombivax HB® Hepatitis B (HepB) None
Twinrix® Hepatitis A & B (HepA-HepB) None
Gardasil 9® Human papillomavirus vaccine (HPV) 9 to 45 years old
Influenza virus Influenza vaccine (flu)

Under 9: 2 vaccines per 180 days
9 and older: 1 vaccine per 180 days

M-M-R II® Measles, mumps, rubella vaccine (MMR) None
ProQuad® Measles, mumps, rubella and varicella vaccine (MMRV) None
Menveo® Meningococcal serogroups A, C, W, Y vaccine (MenACWY-CRM) None
Menactra® Meningococcal serogroups A, C, W, Y vaccine (MenACWY-D) None
MenQuadfi® Meningococcal serogroups A, C, W, Y vaccine (MenACWY-TT) None
Bexsero® Meningococcal serogroup B vaccine (MenB-4C) None
Trumenba® Meningococcal serogroup B vaccine (MenB-FHbp) None
Prevnar 13® Pneumococcal 13-valent conjugate vaccine (PCV13) 65 and older
Vaxneuvance™ Pneumococcal 15-valent conjugate vaccine (PCV15) None
Prevnar 20™ Pneumococcal 20-valent conjugate vaccine (PCV20) None
Pneumovax 23® Pneumococcal 23-valent polysaccharide vaccine (PPSV23) None
IPOL® Poliovirus vaccine (IPV) None
Rotarix® Rotavirus vaccine (RV1) None
RotaTeq® Rotavirus vaccine (RV5) None
Tdvax™ Tetanus and diphtheria vaccine (Td) None
Tenivac® Tetanus and diphtheria vaccine (Td) None
Adacel® Tetanus, diphtheria, and acellular pertussis vaccine (Tdap) None
Boostrix® Tetanus, diphtheria, and acellular pertussis vaccine (Tdap) None
Varivax® Varicella vaccine (VAR) (chickenpox) None
Shingrix® Zoster vaccine (RZV) (Shingles) None

If a member doesn’t meet the age requirement for a vaccine, Blue Cross and BCN won’t cover the vaccine under the prescription drug plan, and the claim will reject.

Vaccines must be administered by certified, trained and qualified registered pharmacists.

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 2021 American Medical Association. All rights reserved.