Pharmacists Increased Vaccination Rates While Reducing Costs

CA pharmacies increased flu, pneumococcal disease and shingles vaccine doses administered by 44.4%

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A new study from UCLA found an easy and cost-effective method to reduce the spread of deadly communicable diseases, such as influenza, pneumococcal infection and human papillomavirus (HPV).

This study says requiring health insurers to pay for adult vaccinations delivered at retail pharmacies could be the missing tactic to save lives and reduce healthcare costs.

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These California researchers found many health insurers do not cover pharmacy-administered vaccines, only cover a limited selection of vaccines, or require people they insure to get vaccinated only at pharmacies within their insurance network.

The UCLA study reported an overall vaccination rate among adult Californians is far below federal recommendations.

For example, the flu vaccination rate in California was 39 percent in 2015-16, 31 percentage points below the 70 percent goal set by Healthy People 2020, which is a federal health promotion program.

Additionally, the pneumococcal immunization rate for Californians 18 to 64 years of age who are at high risk for pneumonia was just 34.1 percent in 2016, compared to the recommended goal of 60 percent.

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“California may be ahead of other states in pushing for health care expansion, but our immunization rates for communicable diseases is fairly dismal,” said Gerald Kominski, senior fellow at the center and one of the study’s co-authors, in a press release. 

Many barriers keep adult Californians from getting immunized, which include:

  • Confusing and inconsistent insurance policy coverage. A patient may have difficulty knowing if their commercial or government insurance program covers pharmacy vaccine benefits. As a result, some customers forgo vaccination because of potential or actual out-of-pocket cost,
  • Unaffordable upfront costs. Some patients are required to pay upfront for vaccinations at a pharmacy and file a claim in order to get reimbursement, a hardship for low-income adults,
  • Lack of access to a doctor. Scheduling an appointment for immunization can be difficult for patients who lack a regular care provider,
  • Unawareness or personal objections. Lack of knowledge about the benefits of adult vaccines; the health system’s focus on childhood vaccinations and its lack of prioritization about adult vaccinations; and cultural suspicion about vaccinations all can hinder immunization.

The Department of Health Care Services Medi-Cal Claims data from calendar years 2016 and 2017 suggest that since opening pharmacies to Medi-Cal Managed Care patients on December 23, 2016, the number of flu, pneumococcal disease and shingles vaccine doses administered has increased by 44.4 percent.

The authors recommend that the California State Legislature require the Department of Managed Health Care and the Department of Insurance follow the lead of Medi-Cal and expand the insurance pharmacy benefit to include adult vaccines for all public and commercial insurance plans.

“Including pharmacy-administered vaccines as a covered benefit will help many adult patients who have financial constraints, transportation issues or are unable to take time off work during a doctor’s office hours,” said Dr. Ozlem Equils, a steering committee member at the Immunization Coalition of Los Angeles County and lead author of the study.

“It’s a step toward making adult immunizations more accessible for more Californians,” said Dr. Equils.

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