Pneumococcal Vaccines

Aetna covers PCV13, PCV15, PCV20 and PPSV23 as medically necessary per ACIP for specified adults (age ≥65 or 19–64 with qualifying conditions) and children (routine PCV15/20 for 2–23 months and catch‑up for 24–59 months or 24–71 months with risk), and considers these vaccines experimental/investigational for groups not listed; PPSV23 is not for children <2 years and is not indicated after prior PCV20. Key requirements: adults may receive PCV15 followed by PPSV23 (typically ≥1 year later) or PCV20 alone; persons who only received PPSV23 should receive PCV15 or PCV20 ≥1 year later, and when PCV15 is used a follow‑up PPSV23 dose is required with ACIP‑specified timing (≥1 year in adults, and shorter intervals for certain high‑risk children).

"CDC recommends 2 doses of either PCV13 or PCV15 if they are unvaccinated or received an incomplete pneumococcal conjugate vaccine series with less than 3 doses before 24 months of age. Give the sec..."