Pharmacy Coverage for Flu Vaccines: Affordable Care Act

Pharmacy Coverage for Flu Vaccines: Affordable Care Act (ACA) Members

9/27/2017

BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan ACA members’ flu vaccines are now covered under the pharmacy benefit at no cost, effective immediately, through the CVS/caremark® Vaccine Network. The Vaccine Network is limited to CVS pharmacies and applies to all ACA members. CVS/caremark is an independent company that provides pharmacy benefit management and pharmacy services on behalf of BlueCross and BlueChoice.

Members must use a CVS pharmacy in order to receive the vaccine with no cost share. Flu vaccines administered in pharmacies other than CVS will be subject to an administrative fee that will be the member’s responsibility. 

Members can also continue to receive flu vaccines at no cost under the medical preventive benefit from network participating medical providers.

Covered Flu Vaccines

The vaccines covered under the program this year are: 

  • Injectable Seasonal Influenza Vaccine

  • Injectable Seasonal Influenza Vaccine-High Dose (Fluzone)

Vaccine Network Lists

Current CVS-Only Vaccine Network lists are posted on our websites.

Non-Seasonal Vaccines*

In addition to seasonal flu vaccines, ACA members can also use the CVS/caremark Vaccine Network to receive some non-seasonal, preventive care vaccines at a no cost under their pharmacy benefit.

*This information details vaccine coverage as it applies to members’ benefits. Vaccine limitations and availability may vary by national guidelines and/or the pharmacy.

If you have questions about this bulletin, please contact Provider Education at 803-264-4730 or submit your question using the Provider Education Contact Form.