Covid-19 vaccine

Some of the most common vaccinations like flu vaccines are covered through your prescription plan. Check with your plan sponsor about specific coverage and copayment information.

If flu vaccines are covered, you and all other members covered by your plan can go to a local participating pharmacy to get the flu shot. Please note, every state has specific regulations regarding age restrictions, which vaccines can be administered by a certified pharmacist, and if a prescription is required.

Data from the Centers for Disease Control and Prevention (CDC) show that in the 2018-19 flu season, only about 45% of adults received their flu shot. This year, more than ever, we encourage as many Americans as possible to get the flu vaccine – even those who haven’t been vaccinated in the past – to help in the fight against COVID-19. It’s especially important for pregnant women, older adults, and people with chronic health conditions to get the flu vaccine not just this year, but every year.

Follow these steps to get vaccinated at your local pharmacy:

Before you visit the pharmacy…

  • Check with your plan sponsor about vaccine coverage and copayment information, if applicable. Please note, for the COVID-19 vaccines, the cost of the vaccine may be covered at no cost (when using a participating retail pharmacy). Check with your plan sponsor about additional coverage information.
  • Make sure the pharmacy you use is part of your Express Scripts participating pharmacy network. If you’re not sure, log in to express-scripts.com and click Find a Pharmacy from the menu under Prescriptions to find out. You can also use the Express Scripts® mobile app on your digital device to locate a participating pharmacy. Please note, for the COVID-19 vaccines, most pharmacies should be able to administer the vaccine, once widely available. Call your pharmacy before visiting, to ensure the pharmacy is able to administer the COVID-19 vaccines, the pharmacy has vaccines available for administration, and to schedule an appointment if one is required by the pharmacy.
  • Call the pharmacy to verify their current vaccination schedule, vaccine availability, and any age restrictions. Please note, every state has specific regulations regarding age restrictions, which vaccines can be administered by a certified pharmacist, and if a prescription is required. Additionally, COVID-19 vaccine availability may vary due to supply and storage constraints, staffing, and/or other factors.

When you get to the pharmacy…

  • Be sure to present your prescription member ID card at the time of service.
  • Be sure to get your vaccine from the pharmacist at the pharmacy, not from the pharmacy’s on-site clinic.

Some of the most common vaccinations like flu vaccines are covered through your prescription plan. Check with your plan sponsor about specific coverage and copayment information.

If flu vaccines are covered, you and all other members covered by your plan can go to a local participating pharmacy to get the flu shot. Please note, every state has specific regulations regarding age restrictions, which vaccines can be administered by a certified pharmacist, and if a prescription is required.

Data from the Centers for Disease Control and Prevention (CDC) show that in the 2018-19 flu season, only about 45% of adults received their flu shot. This year, more than ever, we encourage as many Americans as possible to get the flu vaccine – even those who haven’t been vaccinated in the past – to help in the fight against COVID-19. It’s especially important for pregnant women, older adults, and people with chronic health conditions to get the flu vaccine not just this year, but every year.

Immunizations, more commonly referred to as vaccines, help protect you, your family and friends, and the community from contracting and spreading vaccine-preventable diseases like seasonal flu, whooping cough, measles, shingles, pneumonia, and COVID-19. According to the Centers for Disease Control and Prevention (CDC), we vaccinate not only to protect ourselves and our children from seasonal illnesses like the flu, we vaccinate to protect our future because vaccinations are one of the best ways to put an end to the serious side effects of certain diseases. Additionally, COVID-19 vaccines are one of many important tools to help us take control of this pandemic.

Find out more of what the CDC has to say about the importance of vaccines at www.cdc.gov/vaccines/vac-gen/vaxwithme.html.

All members covered by your prescription plan are eligible to receive plan-covered vaccines at a participating pharmacy. Please note, every state has specific regulations regarding age restrictions, which vaccines can be administered by a certified pharmacist, and if a prescription is required. Check with your local network pharmacy for further clarification.

COVID-19 vaccines are covered through the pharmacy benefit for most plans. Check with your plan sponsor about specific coverage and copayment information.

If COVID-19 vaccines are covered, you and all other members covered by your plan can go to a local participating pharmacy to get the COVID-19 vaccine, once it becomes widely available. Please note, every state has specific regulations regarding age restrictions, which vaccines can be administered by a certified pharmacist, and if a prescription is required. Call your pharmacy before visiting, to ensure the pharmacy is able to administer the COVID-19 vaccines, the pharmacy has vaccines available for administration, and to schedule an appointment if one is required by the pharmacy.

On December 11, 2020, the U.S. Food & Drug Administration (FDA) issued the first emergency use authorization for the COVID-19 vaccine. It is anticipated that the initial vaccine supply will be limited, and therefore allocated to health care personnel and Long-Term Care (LTC) residents and staff. However, the vaccine supply will increase over time and all adults should be able to be vaccinated in 2021.

Express Scripts looks to the FDA and CDC to determine if the COVID-19 vaccines are safe and effective. Express Scripts will make all FDA-approved COVID-19 vaccines available to members, and we will continue to monitor the latest guidance from leading public health organizations to ensure member safety. For more information, visit the CDC’s website.

There are three main platforms that vaccine manufacturers are using to develop COVID-19 vaccines. A central theme is that all vaccine candidates are focusing on developing immunity to the “S protein,” a component of the COVID-19 virus that is critical to allow itself to attach to receptors within our body and infect our cells. By developing vaccines that promote an immune response in our body against this specific protein, the available clinical trial data has shown encouraging results in preventing significant disease and/or transmission. Another difference between the candidates is differing storage requirements which could vary from simple refrigeration to deep freezing.

It is likely several vaccine candidates with be submitted for approval utilizing the FDA’s Emergency Use Authorization (EUA) application. This pathway was originally created after 9/11 to make sure that lifesaving therapies could be available earlier for vulnerable patients.

Initially, hospitals will provide COVID-19 vaccine to health care personnel. As more vaccine is distributed by the federal government, several thousand vaccination providers will be available, including but not limited to doctors’ offices, retail pharmacies, hospitals, and Federally Qualified Health Centers (FQHCs).

Priorities will be outlined in state planning documents but we expect priority will be given to the most vulnerable, such as nursing home residents, along with frontline health care workers. You may periodically check your State Health Department’s site for updates on who is eligible to receive the vaccine. The CDC provides a link to accredited State Departments of Health here.

At this time, the answer is unclear. Viruses tend to mutate over time, plus we do not yet completely understand how long vaccinations may provide protection from COVID-19 infection. This is a matter that will continue to be studied by the medical and scientific community.

If you have already received your first dose of the COVID-19 vaccine, you can register for the Center of Disease Control (CDC) v-safeSM After Vaccination Health Checker. Using your smartphone, you can easily report side effects and even get reminders if you need a second vaccine dose. Remember, getting the vaccine doesn’t replace taking the necessary precautions such as wearing a mask, hand washing, and social distancing. For a full list of COVID-19 safety requirements, visit the CDC's vaccine information page.

The CDC and FDA are reviewing data involving six reported U.S. cases of a rare and severe type of blood clot in people who received the J&J vaccine. These reported cases occurred among women between the ages of 18 and 48. Symptoms occurred 6 to 13 days after vaccination.

These blood clots events appear to be very rare. Nearly seven million patients have received the J&J vaccine with no other reported signs of this type of blood clot. Out of an abundance of caution, the CDC and FDA recommended the use of this vaccine be paused until additional reviews are complete.

Be aware that these blood clots appear to be extremely rare. Nearly seven million patients have received the J&J vaccine with no other reported signs of this type of blood clot. If you received the J&J vaccine and develop severe headaches, abdominal pain, leg pain, or shortness of breath within three weeks after vaccination, please contact your health care provider.

If you were vaccinated at a retail pharmacy, you can easily view your vaccination status in the Express Scripts mobile app.

If you were vaccinated at a mass vaccination site and no claim was filed with Express Scripts, you will need to use your paper vaccination card. You can also check with your local state health registry for verification information.

If you can’t find the answer to your question, please contact us.