Vaccines

Showing 1–12 of 39 results

NAME	ALSO KNOW AS	DRUG CATEGORY	FORMULARY CATEGORY	WHAT WE COVER	COST SHARE
Cholera Vaccine Live Attenuated Susr (Generic)	Vaxchora Susr (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Diph-Tetanus Tox-Acell Pert-Hepatitis B Recomb-Polio Ipv Vac Susp (Generic)	Pediarix Susp (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Diphtheria, Acellular Pertussis & Tetanus Toxoids Susp (Generic)	Infanrix Susp 25-58-10 (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Diphtheria, Acellular Pertussis & Tetanus Toxoids Susp (Generic)	Daptacel Susp 23-15-5 (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Haemophilus B Polysac Conj Vac Solr (Generic)	Acthib Solr (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Haemophilus B Polysac Conj Vac Solr 10Mcg (Generic)	Hiberix Solr 10 Mcg (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Haemophilus B Polysac Conj Vac Susp 7.5Mcg/0.5Ml (Generic)	Pedvax Hib Susp 7.5 Mcg/0.5Ml (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Hepatitis A (Inactivated)-Hepatitis B (Recombinant) Vaccines Susy (Generic)	Twinrix Susy 720-20 Elu-Mcg/Ml (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Hepatitis A Vaccine Susp 1440Elu/Ml (Generic)	Havrix Susp 1440 El U/Ml (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Hepatitis A Vaccine Susp 25Unit/0.5Ml (Generic)	Vaqta Susp 25 Unit/0.5Ml (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Hepatitis A Vaccine Susp 50Unit/Ml (Generic)	Vaqta Susp 50 Unit/Ml (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Hepatitis A Vaccine Susp 720Elu/0.5Ml (Generic)	Havrix Susp 720 El U/0.5Ml (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Hepatitis B Vaccine (Recomb) Susp 10Mcg/0.5Ml (Generic)	Engerix-B Susp 10 Mcg/0.5Ml (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Hepatitis B Vaccine (Recomb) Susp 10Mcg/Ml (Generic)	Recombivax Hb Susp 10 Mcg/Ml (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Hepatitis B Vaccine (Recomb) Susp 20Mcg/Ml (Generic)	Engerix-B Susp 20 Mcg/Ml (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Hepatitis B Vaccine (Recomb) Susp 40Mcg/Ml (Generic)	Recombivax Hb Susp 40 Mcg/Ml (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Hepatitis B Vaccine (Recomb) Susp 5Mcg/0.5Ml (Generic)	Recombivax Hb Susp 5 Mcg/0.5Ml (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Hepatitis B Vaccine Recombinant Adjuvanted Soln 20Mcg/0.5Ml (Generic)	Heplisav-B Soln 20 Mcg/0.5Ml (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Human Papillomavirus (Hpv) 9-Valent Recombinant Vaccine Susp (Generic)	Gardasil 9 Susp (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Human Papillomavirus (Hpv) 9-Valent Recombinant Vaccine Susy (Generic)	Gardasil 9 Susy (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Japanese Encephalitis Vaccine Inactivated Adsorbed Susp (Generic)	Ixiaro Susp (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Measles-Mumps-Rubella-Varicella Virus Vaccines Susr (Generic)	Proquad Susr (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Measles, Mumps & Rubella Virus Vaccines Solr (Generic)	M-M-R Ii Solr (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Meningococcal (A,C,Y&W-135) Oligosaccharide Conjugate Vac Solr (Generic)	Menveo Solr (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Meningococcal (A,C,Y&W-135) Polysaccharide Conjugate Vaccine Inj (Generic)	Menactra Inj (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Meningococcal Group B Vaccine (Recombinant) Susy (Generic)	Trumenba Susy (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Meningococcal Vac Group B (Recombant Omv Adjuvanted) Susy (Generic)	Bexsero Susy (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Poliovirus Vaccine, Ipv Inj (Generic)	Ipol Inj (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Rabies Vaccine, Pcec Susr (Generic)	Rabavert Susr (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Rabies Virus Vaccine, Hdc Inj 2.5Unit/Ml (Generic)	Imovax Rabies Inj 2.5 Unit/Ml (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Rotarix Susr (Brand)	Rotavirus Vaccine, Live Oral Susr (Generic)	Vaccines	3	Non-Formulary Brand	$68
Rotateq Soln (Brand)	Rotavirus Vaccine, Live Oral Pentavalent Soln (Generic)	Vaccines	3	Non-Formulary Brand	$68
Tetanus Toxoid-Diphtheria-Acellular Pertussis Adsorb (Tdap) Susp (Generic)	Boostrix Susp 5-2.5-18.5 Lf-Mcg/0.5 (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Tetanus Toxoid-Diphtheria-Acellular Pertussis Adsorb (Tdap) Susp (Generic)	Adacel Susp 5-2-15.5 Lf-Mcg/0.5 (Brand)	Vaccines	MA	Administered in Medical Office	N/A
Typhoid Vi Polysaccharide Vaccine Soln 25Mcg/0.5Ml (Generic)	Typhim Vi Soln 25 Mcg/0.5Ml (Brand)	Vaccines	MA	Administered in Medical Office	N/A

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