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October 2023

Blue Cross, 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:

Vaccine

Common name and abbreviation

Effective date

Arexvy™


Respiratory syncytial virus, or RSV


July 17, 2023

Abrysvo™

Following are 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 out-of-pocket costs.

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

Vaccines that are covered and have no age requirement

Vaccine

Common name and abbreviation

  • Dengvaxia®

Dengue vaccine — DEN4CYD

  • Daptacel®
  • Infanrix®

Diphtheria, tetanus, and acellular pertussis vaccine — DTaP

  • Diphtheria and tetanus toxoids

Diphtheria, tetanus vaccine — DT

  • Kinrix®
  • Quadracel®

DTap and inactivated poliovirus vaccine — DTaP-IPV

  • Pediarix®

DTaP, hepatitis B, and inactivated poliovirus vaccine — DTaP-HepB-IPV

  • Vaxelis®

DTaP, inactivated poliovirus, Haemophilus influenzae type b, and hepatitis B vaccine — DTaP-IPV-Hib-HepB

  • ActHIB®
  • Hiberix®
  • PedvaxHIB®



Haemophilus influenzae type b vaccine — Hib

  • Havrix®
  • Vaqta®

Hepatitis A — HepA

  • Engerix-B®
  • Heplisav-B®
  • PreHevbrio™    
  • Recombivax HB®

Hepatitis B — HepB

  • Twinrix®

Hepatitis A & B — HepA-HEPB

  • M-M-R II®
  • Priorix®

Measles, mumps, rubella vaccine — MMR

  • ProQuad®

Measles, mumps, rubella and varicella vaccine — MMRV

  • Menveo®

Meningococcal serogroups A, C, W, Y vaccine — MenACWY-CRM

  • Menactra®

Meningococcal serogroups A, C, W, Y vaccine — MenACWY-D

  • MenQuadfi®

Meningococcal serogroups A, C, W, Y vaccine — MenACWY-TT

  • Bexsero®

Meningococcal serogroup B vaccine — MenB-4C

  • Trumenba®

Meningococcal serogroup B vaccine — MenB-FHbp

  • Vaxneuvance™

Pneumococcal 15-valent conjugate vaccine — PCV15

  • Prevnar 20™

Pneumococcal 20-valent conjugate vaccine — PCV20

  • Pneumovax 23®

Pneumococcal 23-valent polysaccharide vaccine — PPSV23

  • IPOL®

Poliovirus — IPV

  • Arexvy™
  • Abrysvo™

Respiratory syncytial virus — RSV

  • Rotarix®

Rotavirus vaccine — RV1

  • RotaTeq®

Rotavirus vaccine — RV5

  • Tdvax®
  • Tenivac®

Tetanus and diphtheria vaccine — Td

  • Adacel®
  • Boostrix®

Tetanus, diphtheria and acellular pertussis vaccine — Tdap

  • Varivax®

Varicella vaccine — VAR or chickenpox

  • Shingrix®

Zoster vaccine — RZV or shingles

Covid vaccines

  • Pfizer-BioNTech COVID-19 vaccine, bivalent
  • Moderna COVID-19 vaccine, bivalent
  • Novavax COVID-19 vaccine

Vaccines with age requirements

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

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 2022 American Medical Association. All rights reserved.