Study: Adult Vaccination Increases With Health Insurers' Pharmacy Benefit

Inconsistency of insurance policy coverage, unaffordability, and difficulty accessing vaccine providers were found to be key barriers for adult immunization in a recent study by UCLA Center for Health Policy researchers.¹ Lack of knowledge about the benefits of vaccination, as well as health system focus on pediatric immunization also were noted as barriers.^1-2

As a solution to many of these barriers and to improve public health, the study’s authors recommended requiring medical insurance plans to cover adult immunizations received in pharmacies.^1-2

“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 Ozlem Equils, a steering committee member at the Immunization Coalition of Los Angeles County and lead author of the study, in a prepared statement.²

Vaccinations are routinely recommended for herpes zoster, human papillomavirus (HPV), pneumococcal disease, Tdap, and hepatitis B, and annually for flu. Many insurers do not cover vaccines administered in pharmacies; cover a limited selection of vaccines; or require people they insure to get vaccinated only at pharmacies within their insurance network, according to study’s results.²

Researchers noted that adult vaccination rates in the United States are consistently lower than the goals set in the United States Department of Health and Human Services’ national Healthy People 2020 objectives. In illustrating their point, investigators noted several examples:¹

• During the 2015-2016 flu season, 39% of noninstitutionalized adults, ages 18 years and older living in California received a flu vaccine, yet the Healthy People 2020 goal was 70% of this population.
• Despite a Healthy People 2020 goal of 80% HPV vaccination completion for women in California aged 18-22 years, the state reported only 22.7% of this population had completed the HPV vaccination series in 2015.
• The pneumococcal immunization rate for adults in California aged 18 to 64 years of age who are at high risk for pneumonia was 34.1% in 2016, far below the recommended Healthy People 2020 goal of 60%.

“California may be ahead of other states in pushing for health care expansion, but our immunization rates for communicable diseases are fairly dismal,” said Gerald Kominski, senior fellow at the center and one of the study’s co-authors, in a prepared statement.²

Influenza and pneumonia-related illnesses contributed to an estimated 57,000 deaths in the United States in 2015-2016, according to the CDC. In California, 324 adults under the age of 65 years died of flu-related illness during the 2017-2018 influenza season as of Aug. 4, according to the California Department of Public Health surveillance report.

In an effort to address adult immunization in California, the state’s Department of Health Care Services (HCS) implemented a plan in 2016 that requires coverage of adult immunizations as a pharmacy benefit. Patients enrolled in the HCS’ Medi-Cal program, a state version of Medicaid, according to the researchers, are eligible to receive recommended vaccines at a health care provider’s office, as well as in pharmacies.¹

“It’s a step toward making adult immunizations more accessible for more Californians,” said Equils, in the statement.²

The effect of Medi-Cal’s required pharmacy benefit has improved access and coverage for adult vaccinations, according to the researchers. Medi-Cal claims data from 2016 and 2017 shows a 44.4% increase in adult flu, pneumococcal disease and shingles vaccinations, suggesting that opening pharmacies to patients had an impact.²

In addition to Medi-Cal, the researchers have recommended that California’s legislature require the state’s Department of Managed Health Care and Department of Insurance to expand the insurance pharmacy benefit to include adult vaccines for all public and commercial insurance plans, according to UCLA.²

Reference

• Equils O, Kellogg C, Berger W, et al. Proposal to Reduce Adult Immunization Barriers in California. Health Policy Brief. UCLA Center for Health Policy Research. Published August 2018. http://healthpolicy.ucla.edu/publications/Documents/PDF/2018/immunizationbarriers-brief-aug2018.pdf. Accessed September 25, 2018.
• Requiring insurers to cover retail pharmacy vaccinations for adult Californians could save lives, study finds [news release]. August 30, 2018. UCLA Office of Media Relations. http://newsroom.ucla.edu/releases/requiring-insurers-to-cover-retail-pharmacy-vaccinations-for-adult-californians-could-save-lives-study-finds?_ga=2.205077909.403355057.1536047145-2048660503.1533287160. Accessed September 25, 2018.