• Acthib: for the prevention of invasive disease caused by Haemophilus influenzae type b
• Fluzone Intradermal: for the prevention of influenza disease caused by influenza A subtype viruses and type B virus contained in the vaccine
• FluMist: for the prevention of influenza disease caused by influenza A subtype viruses and type B viruses contained in the vaccine
  

• Member is 19 years of age or older

AND

• Use is per the Center for Disease Control (CDC) and/or the Advisory Committee on Immunization Practices (ACIP) Guidelines

AND

• For Fluzone Intradermal and FluMist: medical justification for why intramuscular influenza cannot be used.
  

• Non-FDA approved indications, which are not listed in the Health Net Approved Indications and Usage Guidelines section, unless there is sufficient documentation of efficacy and safety in the published literature.

• Any vaccine other than those listed on the Medi-Cal formulary and the vaccines specifically listed in these criteria are not eligible for administration at a pharmacy. Members must contact their primary care physician to obtain any other vaccines.
• Vaccines are available for administration at the pharmacy for adults aged 19 years or older. Members younger than 19 years old must contract their primary care physician.
• The California Vaccines for Children (VFC) Program helps families by providing free vaccines to doctors who serve eligible children 0 through 18 years of age. Enrolled VFC providers are able to order vaccine through the program and receive routine vaccines at no cost. For more information visit eziz.org
• FluMist is a live attenuated influenza vaccine and is not recommended for use in pregnant women, immunosuppressed persons, or persons who have taken influenza antiviral medications within the previous 48 hours. Persons who care for severely immunosuppressed persons who require a protective environment should not receive FluMist, or should avoid contact with such persons for 7 days after receipt.
• FluMist is approved for use in persons 2 through 49 years of age.
• FluZone Intradermal is approved for use in persons 18 through 64 years of age.
• Medi-Cal vaccines eligible for administration at a pharmacy include:

• Adult use of Haemophilus influenzae type b (Hib) vaccination includes:
• One dose of Hib vaccine should be administered to persons who have anatomical or functional asplenia or sickle cell disease or are undergoing elective splenectomy if they have not previously received Hib vaccine. Hib vaccination 14 or more days before splenectomy is suggested.
• Recipients of a hematopoietic stem cell transplant (HSCT) should be vaccinated with a 3-dose regimen 6–12 months after a successful transplant, regardless of vaccination history; at least 4 weeks should separate doses.
• Hib vaccine is not recommended for adults with HIV infection since their risk for Hib infection is low.

Acthib: single-dose vial with single-dose diluent vial
Fluzone Intradermal: 0.1 mL single-dose prefilled microinjection system
FluMist: 0.2 mL single-dose prefilled intranasal sprayer

1. ActHIB (Haemophilus B conjugate vaccine) [prescribing information]. Swiftwater, PA: Sanofi Pasteur Inc; December 2015. Accessed June 24, 2016.
2. Centers for Disease Control and Prevention (CDC). Recommended Adult Immunization Schedule. Recommendations of the Advisory Committee on Immuization Practices-United States, 2016, cdc.gov,
3. FluMist [prescribing information] Gaithersburg, MD: MedImmune, LLC; July 2013. Accessed June 24, 2016.
4. Fluzone [prescribing information] Swiftwater, PA: Sanofi Pasteur Inc; June 2015. Accessed June 24, 2016.