Prevnar 13® and Pneumovax® 23 are available as a pharmacy benefit with $0 copay in L.A. Care's "Covered California" (L.A. Care Covered™), "Covered California Direct" (L.A. Care Covered Direct™) and "In-Home Supportive Services" (PASC-SEIU Plan) Lines of Business, and may still be administered at a medical office.
The vaccines were already available for L.A. Care’s "Medi-Cal" (MCLA) and "Cal Medi-Connect" (CMC) Lines of Business.
L.A. Care Formulary Coverage of Pneumococcal Vaccine
PREVNAR 13 INJ (Brand Drug) | Pneumococcal conjugate vaccine (Generic)
- MCLA: Formulary PA, QL*
- CMC: Part B benefit
- PASC: VAC ($0) PA, QL*
- LACC/LACCD: VAC ($0) PA, QL*
PNEUMOVAX INJ (Brand Drug) | Pneumococcal polysaccharide vaccine (Generic)
- MCLA: Formulary
- CMC: Part B benefit
- PASC: VAC ($0)
- LACC/LACCD: VAC ($0)
*PA=Prior Authorization (required for members less than 19 years of age); QL=Quantity Limit (limit 1 fill for lifetime for members 19 years of age or older)
Vaccination Schedule
As a reminder, the Centers for Disease Control and Prevention (CDC) recommends the following routine vaccination schedule for adults 19 years of age and older:
Pneumococcal conjugate vaccine (PCV13 or Prevnar 13®)
- All adults 65 years of age or older
- People 2 to 64 years old with certain medical conditions
Pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax® 23)
- All adults 65 years of age or older
- People 2 to 64 years old with certain medical conditions
- People 19 to 64 years old who smoke cigarettes
Please refer to the CDC immunization schedules for more information. You can also contact us at 1.866.LA.CARE6 (1-866-522-2736) if you have questions about pneumococcal vaccine coverage for your patients.