Advantage Plus Pharmacy Benefits
Vaccines
Where can you get your flu vaccine and other vaccines?
Effective immediately, you can get your seasonal flu vaccine covered at $0 copay through your pharmacy benefit by visiting any network pharmacy. You can also visit your primary care physician. Need to find one?
You can also visit a participating pharmacy within South Carolina or the entire U.S. to get some non-seasonal preventive care vaccines at a $0 copay. A chart of these vaccines is as follows:
| Vaccine | Min. Age | Max. Age |
|---|---|---|
| Combination Pediatric (Pediarix, Pentacel, Quadracel, Kinrix, Vaxelis) | Pediatric | --- |
| Haemophilus B (Hib) (ActHIB, Hiberix, PedvaxHIB) | --- | 6 years |
| Hepatitis A & B (Engerix-B, Heplisav-B (≥18), Twinrix) | --- | --- |
| HPV (Gardasil 9) | 9 years | 45 years |
| Meningococcal (MenQuadfi, Menveo, Bexsero, Trumenba, Penbraya, Penmenvy^) | --- | --- |
| MMR & Varicella (M-M-R II, Priorix, ProQuad (MMRV) (≤12), Varivax) | --- | --- |
| Pneumococcal (Capvaxive (≥18), Prevnar 20, Pneumovax 23, Vaxneuvance) | 6 weeks | --- |
| Polio (IPV) (IPOL) | --- | 17 years |
| Rotavirus (Oral) (Rotarix, RotaTeq) | --- | 8 months |
| RSV (Abrysvo* (pregnancy, ≥50), Arexvy (≥50), mRESVIA (≥50), Beyfortus (≤24 mos) | --- | --- |
| Smallpox & Mpox (Jynneos) | 18 years | --- |
| Pediatric Toxoid Combinations: DTap (Daptacel, Infanrix) | Pediatric | --- |
| Adult Toxoid Combinations: Tdap/Td (Adacel , Boostrix , TdVax, Tenivac, TET/DIP TOX) | --- | --- |
| Zoster (Shingles) (Shingrix (≥50 or immunocompromised ≥18) | 18 years | --- |
^ Approved Feb. 2025; first pentavalent MenABCWY vaccine for ages 10–25.
*Only RSV vaccine approved for use during pregnancy (32-36 weeks gestation).
Any questions about your pharmacy benefit can be answered by calling Member Services. Just call the number on the back of your member ID card.
Drug Tiers
| Your Cost | Drug Tier | Usually Includes |
|---|---|---|
| $ | Tier 1 | Lowest-cost prescription generic and some over-the-counter drugs. |
| $$ | Tier 2 | Prescription generic and some over-the-counter drugs. |
| $$$ | Tier 3 | Brand-name drugs that don't have a generic available. Also may include higher priced generics that have more cost-effective options at lower tiers. |
| $$$$ | Tier 4 | Brand-name drugs that have brand or generic options at lower tiers. Also may include higher-priced generics that have more cost-effective options at lower tiers. |
| $$$$$ | Tier 5 | Specialty drugs* that are more cost-effective than other specialty drugs that treat the same conditions. Also may include some non-specialty brand or generic drugs that have more cost-effective options at lower tiers. |
| $$$$$$ | Tier 6 | Specialty drugs that have more cost-effective alternatives at Tier 5. Also, may include some non-specialty brand or generic drugs that have more cost-effective options at lower tiers. |
*Specialty drugs are prescription medications that are used to treat complex or chronic medical conditions, such as cancer, rheumatoid arthritis, multiple sclerosis and hepatitis C.
Please note that if a plan has a brand deductible, any tier 3 or tier 4 medication will process to that deductible before applying benefits.