The Power of Vaccines

Wayne   •   July 11, 2017

Did You Know?

During the 2015-2016 flu season, the flu was responsible for:

25 million flu illnesses

11 million flu-related medical visits

310,000 hospitalizations

12,000 Pneumonia & Influenza (P&I) deaths

However, the flu vaccine prevented an additional:

5.1 million flu illnesses

2.5 million flu-related medical visits

71,000 hospitalizations1

U.S. Vaccination Rates Need Improvement

While vaccines are becoming increasingly accessible, vaccination rates are still far from desirable and well below government goals. A study from the University of North Carolina2 found that over the 2015-2016 flu season, “the flu accounted for $5.8 billion in health care and lost productivity costs. Some 80 percent of those losses were tied to people who chose not to get vaccinated.”

Time to Take Action

We know, we know. It’s still summer! Why are we talking about the flu already?

The flu season may vary geographically, but is usually considered to run from August/September through March/April, with a seasonal peak around February — which means it’s right around the corner!

Coverage mandates are required under the Affordable Care Act (ACA) for many vaccines, including the flu, but the way coverage is handled is at the plan’s discretion. A plan may cover under the medical benefit alone or under both the medical and pharmacy benefit. Many people receive their flu vaccine from their local pharmacist, while others may need to rely on their doctor’s office for their shot. Some employers even arrange to bring someone in to administer the flu vaccine to their employees while at work.

Cover Your Participants Under Your Pharmacy Benefits Plan

Some plans still don’t cover immunizations under the pharmacy benefit, which is unfortunate as pharmacists are one of the most accessible and convenient health care professionals.  Coverage under the pharmacy benefit can be added very easily and tends to be more cost-effective than the medical benefit. Pharmacies that are unable to process immunizations under a pharmacy benefit may still engage in immunization services but may have to bill the plan participant’s medical benefit or request payment up front and inform the individual to seek reimbursement from their medical provider. This provides extra hassle to plan participants and may result in higher costs to them as well as plan sponsors.

The flu causes millions of illnesses, hundreds of thousands of hospitalizations and thousands of deaths every season. By being proactive, you can help keep both your workforce and your bottom line healthy. Help your participants get vaccinated by ensuring they have easy and cost-effective access.  If you want to implement or re-enroll in CVS/caremark’s Broader Vaccination Network, contact your Account Manager today!

 

  1. Influenza (Flu). (2017, April 19). Retrieved June 15, 2017, from https://www.cdc.gov/flu/about/disease/2015-16.htm
  1. Morris, C., & CNBC.com, S. T. (2016, October 28). The $5.8 billion hidden cost of the flu on the US economy. Retrieved June 15, 2017, from http://www.cnbc.com/2016/10/28/the-58-billion-hidden-cost-of-the-flu-on-the-us-economy.html