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We are covering FluMist for the 2018-2019 season
October 3, 2018

For the 2018-2019 flu season, Blue Cross will cover:

  • The cost of the flu shot vaccine for all members ages six months and older, and
  • NEW this season: the FluMist Quadrivalent nasal spray flu vaccine both at the provider level and at the pharmacy.

You may recall that the Centers for Disease Control (CDC) did not approve FluMist last year because it didn’t protect against H1N1. Since then, the H1N1 virus has been added to the formulation, and children tested appear to be mounting a response to H1N1.

About the FluMist
FluMist is recommended for members between 2 and 49 years old. It is not recommended for those who are pregnant, children with asthma, those who are allergic to eggs, and other medical conditions. Members should check with their physician to make sure the nasal vaccine is appropriate for them.  

FluMist also works against B viruses and the H3N2 of recent years, according to Dr. Tom Hawkins, senior medical director. “So far through the spring 2018, H1N1 seems to be equivalent or predominating over H3N2, with B at lower levels,” said Dr. Hawkins.

Recommended vaccine composition for the U.S. 2018-2019 influenza vaccines
The World Health Organization recommends that standard (quadrivalent) vaccines for use in the 2018-2019 northern hemisphere influenza season contain the following1:

  • A/Michigan/45/2015 (H1N1) pdm09-like virus
  • A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus
  • B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage)
  • B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage)
  • For the 2018–2019 U.S. influenza season, you may choose to administer any licensed, age-appropriate influenza vaccine (IIV, recombinant influenza vaccine [RIV], or LAIV42. Please be sure to bill only for codes listed on your fee schedule if you have a specific list in your contract. Check your fee schedule for covered codes.
  • LAIV4 is an option for those for whom it is otherwise appropriate. No preference is expressed for any influenza vaccine product. ACIP3 will continue to review data about the effectiveness of LAIV4 as they become available. Please note that the effectiveness of the updated LAIV4 containing A/Slovenia/2903/2015 against currently circulating influenza A (H1N1) pdm09-like viruses is not yet known.4

How to learn more and bill for reimbursement

  • Log in and go to Clinical Resources>Clinical Programs & Information>Treatment Resources then click on Flu. Scroll down to the "Member Benefits" section and click on flu vaccinations.
  • For more flu-related information, visit bluecrossma.com/flu.

  1. http://www.who.int/influenza/vaccines/virus/recommendations/2018_19_north/en/
  2. Live attenuated influenza vaccine (LAIV)
  3. CDC Advisory Committee on Immunization Practices (ACIP)
  4. https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a5.htm

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