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August 2024

Blue Cross, BCN cover 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 has added the following to our list of vaccines covered under the pharmacy benefit:

Common name

Vaccine

Effective date


Smallpox and mpox (previously monkeypox) vaccine

Jynneos®


May 7, 2024

The following 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.

Vaccines with age requirements

Common name

Vaccine

Human papillomavirus vaccine, or HPV

Gardasil 9®
9 to 45 years old

Vaccines with no age requirements

Common name

Vaccine

COVID-19, or 1vCOV-aPS

  • Novavax

COVID-19, or 1vCOV-mRNA

  • Comirnaty®/Pfizer-BioNTech
  • Spikevax®/Moderna

Dengue, or DEN4CYD

 

  • Dengvaxia®

Diphtheria, tetanus, and acellular pertussis, or DTaP

 

  • Daptacel®
  • Infanrix®

DTaP and inactivated poliovirus, or DTaP-IPV

  • Kinrix®
  • Quadracel®

DTaP, hepatitis B, and inactivated poliovirus, or DTaP-HepB-IPV

  • Pediarix®

DTaP, inactivated poliovirus, and Haemophilus influenza type b, or DTaP-IPV-Hib

  • Pentacel®

DTaP, inactivated poliovirus, Haemophilus influenza type b, hepatitis B, or DTaP-IPV-Hib-HepB

  • Vaxelis®

Haemophilus influenza type b, or Hib PRP-OMP

  • PedvaxHIB®

Haemophilus influenza type b, or Hib PRP-T

  • ActHIB®
  • Hiberix®

Hepatitis A, or HepA

  • Havrix®
  • Vaqta®

Hepatitis A and B, or HepA-HepB

  • Twinrix®

Hepatitis B, or HepB

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

Influenza virus

  • Influenza vaccine (flu)

Measles, mumps, rubella, or MMR

  • M-M-R II®
  • Priorix®

Measles, mumps, rubella and varicella, or MMRV

  • ProQuad®

Meningococcal serogroups A, C, W, Y, or MenACWY-CRM

  • Menveo®

Meningococcal serogroups A, C, W, Y, or MenACWY-TT

  • MenQuadfi®

Meningococcal serogroups A, B, C, W, Y vaccine, or MenACWY-TT/MenB-FHbp

  • Penbraya™

Meningococcal serogroup B, or MenB-4C

  • Bexsero®

Meningococcal serogroup B, or MenB-FHbp

  • Trumenba®

Mpox

  • Jynneos®

Pneumococcal conjugate, or PCV15

  • Vaxneuvance™

Pneumococcal conjugate, or PCV20

  • Prevnar 20®

Pneumococcal polysaccharide, or PPSV23

  • Pneumovax 23®

Poliovirus, or IPV

  • Ipol®

Respiratory syncytial virus, or RSV

  • Abrysvo™
  • Arexvy®

Respiratory syncytial virus monoclonal antibody, or RSV-mAB

  • Beyfortus™

Rotavirus, or RV1

  • Rotarix®

Rotavirus, or RV5

  • RotaTeq®

Tetanus and diphtheria, or Td

  • TdVax™
  • Tenivac®

Tetanus, diphtheria, and acellular pertussis, or Tdap

  • Adacel®
  • Boostrix®

Varicella, or VAR, chickenpox

  • Varivax®

Zoster, or RZV, shingles

  • Shingrix

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 2023 American Medical Association. All rights reserved.