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Which Flu Vaccine Should You Get?

by The GoodRx Pharmacist on October 1, 2014 at 11:56 am

The flu can change from year to year—and to keep up, the flu vaccine must be tweaked every flu season. Fortunately, this also means that each year more tools become available to fight the flu. This year, there are more types of flu vaccine to choose from, and healthcare providers such as pharmacists and pharmacy interns (in some states) can administer your vaccine, making it easier than ever to keep you healthy.

To begin with, you should know that the different types of flu vaccination vary by how they’re given and by the type of vaccine.

What are the options for how to get the flu vaccination?

  • Intramuscular. This is the most common option, a regular flu shot into the muscle of your arm. It is the way most adults receive their flu shot. Adults, children, and the elderly may get an intramuscular flu shot.
  • Intradermal. This type of shot uses a much smaller needle and is injected into the skin instead of the muscle. It also uses less antigen (the substance used to create protection against the flu) in order to be effective. It is for adults only, ages 18 through 64.
  • Nasal. Nasal sprays are exactly that—no shot required. Adults and children may get the nasal spray vaccine, with a couple of notes: it isn’t recommended over age 49, and this year, it is the preferred option for children ages 2 through 8. What if the nasal spray isn’t available in your area? The CDC recommends getting the regular intramuscular shot instead rather than waiting, for all ages.

What types of flu vaccine are available?

  • Trivalent vaccinations protect against three strains of the flu. Like the intramuscular shot, this is the most common form of the vaccine.
  • High Dose (also trivalent) vaccinations contain four times the antigens of the regular flu shot. High dose shots are approved for ages 65 and older to help promote a better immune response and better protection.
  • Quadrivalent vaccinations protect against four strains of the flu. The addition of the extra strain can offer better protection than the trivalent vaccine. This year, the nasal spray vaccine is quadrivalent.

Really though, what’s the difference between the trivalent and quadrivalent vaccines?

To break it down even more: the trivalent vaccine protects against two influenza A viruses (H1N1 and H3N2) and one influenza B virus. The quadrivalent vaccine also protects against two influenza A viruses, but includes antigens for an extra influenza B virus (two total) for extra protection.

I have an egg allergy. Can I still get the flu shot?

Yes. FluBlok does not contain eggs and eggs are not used in any part of making the vaccine. It is safe to use for adults ages 18 to 49 with egg allergies.

What is Flucelvax, and who is it for?
Flucelvax is the first and only flu vaccine that has been approved by the FDA to use cell culture technology. This means that it is produced in closed bioreactors (basically huge metal drums) eliminating the need to use antibiotics to create the vaccine.

Flucelvax is an alternative choice for the flu vaccine that does not contain antibiotics or preservatives. It is safe to use in adults 18 years of age and older. However, Flucelvax does still contain egg protein—FluBlok is the ONLY vaccine indicated for those with an egg allergy.

There are so many choices! Which one should I get?

Your doctor, pharmacist, or other healthcare provider can help determine which vaccine is right for you. Your options may be limited by age, health, or allergies. Always let your healthcare provider know before you get vaccinated if you have ANY allergies, including medications and foods.

So you’re aware of all of the options out there, here’s the full list:


  • Standard dose intramuscular trivalent grown in eggs (inactivated vaccine)
  • Standard dose intramuscular trivalent grown in cell culture (inactivated vaccine)
    • Approved for use in adults 18 years and older.
    • Vaccine brand: Flucelvax
  • Recombinant intramuscular trivalent egg-free (inactivated vaccine)
    • Approved for use in adults ages 18 to 49
    • Vaccine brand: FluBlok
  • Intradermal trivalent (inactivated vaccine)
  • High dose intramuscular trivalent (inactivated vaccine)


  • Quadrivalent nasal spray (live vaccine)
    • Approved for use in children and adults ages 2 to 49
    • Preferred for use in children ages 2 to 8
    • Vaccine brand: Flumist Quadrivalent

What is the most common flu shot?

Most adults will receive the inactivated standard dose trivalent flu shot unless you have an allergy, you request one of the other options (quadrivalent, intradermal, or nasal spray), or it’s otherwise contraindicated. Again, these include Afluria, Fluarix, FluLaval, Fluvirin, and Fluzone.

Most adults 65 years of age and older will receive the inactivated trivalent high dose flu shot, Fluzone High-Dose.

Will my prescription drug insurance cover the cost of the flu shot?

Maybe. If you’re insured through your employer, every plan is unique, so unfortunately there is no simple answer to this question. If you are covered, keep an eye out for information on when and how to get your shot. Some employers will offer on-site flu clinics free of charge. Others may provide a voucher to take the pharmacy.

Some good news this year though—flu shots are covered at no cost to you on any plans purchased through the marketplace.

Will Medicare B cover the flu shot?

Medicare B typically covers one flu shot per season at no cost to you if you meet their conditions. Be aware though that if your doctor recommends other services or treatments that may not be covered (or if you receive a shot more than once per year), you may still receive a bill. Be sure to review your coverage with your plan or on

What if my insurance won’t cover the vaccine?

There are still options! Various clinics and other organizations are offering FREE flu shots this month, so be sure to check with your local health department and in the news to find out if there any in your area.

For examples and more tips on how to get a free or reduced cost flu shot, see our post here.

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