November 2023
Blue Cross and BCN covering additional vaccines
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 vaccines to our list of vaccines covered under the pharmacy benefit:
- Pfizer COVID-19 vaccine (2023-2024), 6 months to 4 years old
- Pfizer COVID-19 vaccine (2023-2024), 5 to 11 years old
- Novavax COVID-19 vaccine (2023-2024)
- Comirnaty, Pfizer COVID-19 vaccine (2023-2024)
- Spikevax, Moderna COVID-19 vaccine (2023 -2024)
For information about the procedure codes to use when billing for these vaccines, see the article “Updated COVID-19 vaccines approved by FDA,” also in this issue.
Vaccine list
Following is a list of 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.
Vaccines that have an age requirement
Vaccine |
Common name and abbreviation |
Age Requirement |
Gardasil 9® |
Human papillomavirus vaccine – HPV |
9 to 45 years old |
Influenza virus |
Influenza vaccine – Flu |
Younger than 9: 2 vaccines per 180 days
9 and older: 1 vaccine per 180 days |
Prevnar 13® |
Pneumococcal 13 – valent conjugate vaccine |
65 and older |
Vaccines that have no age requirement
Vaccine |
Common name and abbreviation |
|
Dengue vaccine – DEN4CYD |
|
Diphtheria, tetanus, and acellular pertussis vaccine – DTaP |
- Diphtheria and Tetanus Toxoids
|
Diphtheria, tetanus vaccine – DT |
|
DTap and inactivated poliovirus vaccine – DTaP-IPV |
|
DTaP, hepatitis B, and inactivated poliovirus vaccine – DTaP-HepB-IPV |
|
DTaP, inactivated poliovirus, Haemophilus influenzae type b, and hepatitis B vaccine – DTaP-IPV-Hib-HepB |
- ActHIB®
- Hiberix®
- PedvaxHIB®
|
Haemophilus influenzae type b vaccine – Hib
|
|
Hepatitis A – HepA |
- Engerix-B®
- Heplisav-B®
- PreHevbrio™
- Recombivax HB®
|
Hepatitis B – HepB |
|
Hepatitis A & B – HepA-HEPB |
|
Measles, mumps, rubella vaccine – MMR |
|
Measles, mumps, rubella and varicella vaccine – MMRV |
|
Meningococcal serogroups A, C, W, Y vaccine – MenACWY-CRM |
|
Meningococcal serogroups A, C, W, Y vaccine – MenACWY-D |
|
Meningococcal serogroups A, C, W, Y vaccine – MenACWY-TT |
|
Meningococcal serogroup B vaccine – MenB-4C |
|
Meningococcal serogroup B vaccine – MenB-FHbp |
|
Pneumococcal 15-valent conjugate vaccine – PCV15 |
|
Pneumococcal 20-valent conjugate vaccine – PCV20 |
|
Pneumococcal 23-valent polysaccharide vaccine – PPSV23 |
|
Poliovirus – IPV |
|
Respiratory syncytial virus – RSV |
|
Rotavirus vaccine – RV1 |
|
Rotavirus vaccine – RV5 |
|
Tetanus and diphtheria vaccine – Td |
|
Tetanus, diphtheria and acellular pertussis vaccine – Tdap |
|
Varicella vaccine – VAR (chickenpox) |
|
Zoster vaccine – RZV (shingles) |
COVID-19 vaccines
- Pfizer COVID-19 vaccine (2023-2024), 6 months to 4 years
- Pfizer COVID-19 vaccine (2023-2024), 5 to 11 years
- Novavax COVID-19 vaccine (2023-2024)
- Comirnaty, Pfizer COVID-19 vaccine (2023-2024)
- Spikevax, Moderna COVID-19 vaccine (2023-2024)
Notes:
- 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.
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