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September 2018

Information updated for the use of some Rx vaccines

Below we’ve included some guidelines and information about various vaccines covered under the pharmacy benefit and their use for our members. This information applies to PPO and HMO members.

Flu vaccines

  • FluMist®, also called live attenuated influenza vaccine, has been approved for use in nonpregnant individuals, ages 2 through 49. The following people with some medical conditions should not receive the nasal spray flu vaccine:
    • Children younger than age 2
    • Adults ages 50 and older
    • Pregnant women
    • People with a history of severe allergic reaction to any component of the vaccine or to a previous dose of any influenza vaccine
    • Children ages 2 through 17 who are receiving aspirin or salicylate-containing medications
    • People with weakened immune systems (immunosuppression)
    • Children ages 2 through 4 who have asthma or who’ve had a history of wheezing in the past 12 months
    • People who’ve taken influenza antiviral drugs within the previous 48 hours
    • Caretakers for severely immunocompromised people who require a protected environment (Otherwise, avoid contact with those people for seven days after getting the nasal spray vaccine)

Quantity limits

Quantity limits will be placed on the following vaccines, effective Sept. 1, 2018, unless otherwise noted. These limits will help prevent billing vaccines for greater quantities than recommended. The dosage for each vaccine is based on the recommended standard.

  • Menactra®
  • Pneumovax® 23
  • Boostrix® and Boostrix® TDAP
  • Gardasil® and Gardasil® 9
  • Havrix® (Adolescent dose)
  • Vaqta® (Adolescent dose)
  • Havrix® (Adult dose)
  • Vaqta® (Adult dose)
  • Prevnar®
  • Menveo® (effective Aug. 1, 2018)

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 2017 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.