Blue Cross and Blue Shield of North Carolina (Blue Cross NC) remains committed to ensuring our members, including children, have access to vaccines as part of their preventive care.

As of January 5, 2026, the Centers for Disease Control and Prevention (CDC) updated their childhood immunization schedule. Blue Cross NC’s vaccination coverage has not changed. Members can continue to receive vaccines with no out-of-pocket cost from in-network providers, and are advised to consult with their provider for guidance on routine child and adolescent vaccination. 

Please direct members to the Blue Cross NC preventive care page for continued updates on coverage for all preventive services, including vaccines. Any services listed on the preventive care page are covered at 100% for all members when billed as preventive at in-network providers. 

Eligibility guidance

• As of January 5, 2026, the CDC updated their childhood immunization schedule to now recommend vaccination for hepatitis A (Hep A), hepatitis B (Hep B), meningococcal disease, rotavirus (RV), influenza, and respiratory syncytial virus (RSV) only for high-risk children or after consultation with a health care provider.
• Under the new approvals, CDC recommends shared clinical decision-making for RV, COVID-19, influenza, Hep A, Hep B, and meningococcal vaccines, allowing families and clinicians to determine vaccination based on individual circumstances. 
• CDC’s updated recommendations include that all children be immunized against measles, mumps, rubella, polio, diphtheria, tetanus, pertussis, Haemophilus influenzae type b (Hib), pneumococcal disease, human papillomavirus (HPV), and varicella (chickenpox). 

What’s covered

• Blue Cross NC’s vaccine coverage has not changed.
• Children covered by a Blue Cross NC policy can receive the Hep A, Hep B, meningococcal, RV, influenza, and respiratory syncytial virus RSV vaccines at no out-of-pocket cost when billed as preventive and administered by in-network providers.
• Coverage applies whether the vaccine is administered in a primary care setting or pharmacy.

Provider responsibilities

• Providers, including doctors, nurses, and pharmacists, should guide members based on their best clinical judgment.
• Follow clinical guidelines from the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), the American Medical Association (AMA), the American College of Obstetricians and Gynecologists (ACOG), and other leading medical organizations when administering vaccines.
• Educate patients on vaccine availability and importance. 
• Reimbursement: Rates align with Blue Cross NC’s April 1, 2025, fee schedule.

Pharmacy administration

• ACIP classifies pharmacists as providers who can administer the vaccine under a shared clinical decision-making framework. 
• Members do not need a prescription from a primary care provider to receive a vaccine at a retail pharmacy. 
• Pharmacists must follow the laws of the state in which they practice when administering all vaccines.

Additional provider resources 

• Please direct members to the Blue Cross NC preventive care page for updates.
• Per the Blue Cross Blue Shield Association announcement, “Blue Cross and Blue Shield (BCBS) companies are committed to ensuring access to vaccines that protect individuals and communities from serious illness. The decision to receive a vaccine is made between patients and their health care providers and we remain committed to maintaining rigorous, evidence-based processes to evaluate coverage policies. BCBS companies will continue covering all immunizations that were recommended by the Advisory Committee on Immunization Practices (ACIP) on January 1, 2025, with no cost-sharing through 2026, while operating within federal and state laws and meeting program and customer requirements.”