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 |
|---|---|---|
| HAEMOPHILUS B | --- | 6 years |
| HEPATITIS A (INACTIVATED)-HEPATITIS B (RECOMBINANT) VACCINE | --- | --- |
| HEPATITIS A VACCINE | --- | --- |
| HEPATITIS B VACCINE | --- | --- |
| HEPATITIS B VACCINE RECOMB ADJUVANTED PREF SYR 20 MCG/0.5ML | 18 years | --- |
| HUMAN PAPILLOMAVIRUS (HPV) | 9 years | 26 years |
| MENINGOCOCCAL | --- | --- |
| PNEUMOCOCCAL | --- | --- |
| POLIOVIRUS VACCINE, IPV | --- | 17 years |
| RESPIRATORY SYNCYTIAL VIRUS VACCINE [RECOMBINANT] (Abrysvo 120 mcg/0.5 mL) * | --- | --- |
| RESPIRATORY SYNCYTIAL VIRUS VACCINE [RECOMBINANT (ADJUVANTED)] (Arexvy 120 mcg/0.5 mL) * | --- | --- |
| ROTAVIRUS VACCINE, LIVE ORAL | --- | 8 months |
| TOXOID COMBINATIONS | --- | --- |
| VARICELLA VIRUS VACCINE LIVE | --- | |
| VIRAL VACCINE COMBINATIONS | --- | --- |
| ZOSTER VAC RECOMBINANT ADJUVANTED FOR IM INJ 50 MCG/0.5ML | 19 years | --- |
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.