Transcription of Vaccines Covered under your Pharmacy Benefit - Florida Blue
1 Generics = lower case Brands = CAPITAL LETTERS (Gen ricos = letras min scula Marca = LETRAS MAY SCULA) v050918 Florida blue is an Independent Licensee of the blue Cross and blue Shield Association Florida blue is an Independent Licensee of the blue Cross and blue Shield Association Page 1 of 1 Vaccines Covered under your Pharmacy Benefit (Vacunas cubiertas bajo sus beneficios de farmacia) Current (Correinte) 1/1/20 *These Vaccines may be Covered under your medical Benefit . NOTE: Coverage for preventive services are subject to the member s Benefit terms, limitations and maximums. ACTHIB ADACEL AFLURIA AGRIFLU* BEXSERO BOOSTRIX CERVARIX* COMVAX* DAPTACEL DIPHTHERIA/TETANUS TOXOID ENGERIX-B FLUAD FLUBLOK FLUCELVAX FLUARIX FLULAVAL FLUMIST FLUVIRIN* FLUZONE/HIGH-DOSE/ GARDASIL HAVRIX HEPLISAV HIBERIX INFANRIX IPOL INACTIVATED IPV* KINRIX MEDICAL PROVIDER SINGLE U influenza MENACTRA MENHIBRIX* MENOMUNE A/C/Y/W-135* MENVEO M-M-R II W/DILUENT 10 DOS PEDIARIX PEDVAX HIB PENTACEL PROQUAD PNEUMOVAX 23 PREVNAR 13 QUADRACEL RECOMBIVAX HB SHINGRIX (age 50 and over) TDVAX TENIVAC TETANUS TOXOID ADSORBED TETANUS/DIPHTHERIA TOXOID TWINRIX VAXCHORA VAQTA VARIVAX VIVOTIF ZOSTAVAX (age 50 and over)
