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