Adult Vaccination Rates Could Improve if Insurance Covered Pharmacy Shots

September 6, 2018

There could be significant gains in adult vaccination rates if Insurers were required to cover vaccinations in pharmacies

Requiring insurers to cover pharmacy-administered vaccines could significantly improve adult vaccination rates in California, according to a new policy brief from the Fielding School of Public Health at the University of California, Los Angeles.

The brief recommends expanding a policy adopted by the state's Medi-Cal program in 2016, which requires coverage of recommended adult vaccines as a pharmacy benefit.

The authors of the study believe that by expanding this requirement to other insurance plans, it could help reduce barriers to vaccination that continue to plague the state.

"If our recommendation was adopted by the state legislature, commercial insurers would also be required to provide coverage of vaccines as a pharmacy benefit, which would enhance the role of retail pharmacies in improving vaccination rates and moving California closer to Healthy People 2020 goals," Gerald F. Kominski, PhD, a coauthor of the brief and professor in the Department of Health Policy and Management at UCLA, tells Drug Topics.

The Healthy People 2020 initiative has set out specific goals and objectives to help improve vaccination rates, but California's adult immunization rates fall well below these goals.

According to the brief, only 39% of adults in California received the flu vaccine during the 2015-2016 flu season, which falls significantly short of the Healthy People 2020 goal of 70%. The vaccination goal for high-risk individuals or those who are institutionalized is 90%, but California also currently falls short of that, at just 42%.

The rates for other adult vaccinations are also low.

The reasons for the low adult vaccination rates are multifaceted and include such obstacles as confusing and inconsistent insurance policy coverage, unaffordable upfront costs, a lack of access to a physician, a lack of awareness that adult vaccines are needed, and personal objections, according to the brief.

The team at UCLA believes some of these obstacles would be overcome if insurers were required to cover pharmacy-administered vaccines, giving patients a convenient place to be vaccinated.

"Providing access to vaccines at retail pharmacies for adults with either public or commercial insurance plans would make access easier for all patients, particularly those who have socioeconomic and transportation challenges and are at the highest risk for vaccine-preventable disease," the authors write in the brief.

They believe access would be improved because patients wouldn't have to wait for an appointment with their doctor, and could go to a nearby pharmacy, which often has more flexible hours and doesn't require appointments. Many pharmacists are already specially trained to administer vaccines.

After the state's Medi-Cal program adopted such a policy in 2016, it saw significant increases in the number of doses administered. During 2016 and 2017, the number of flu, pneumococcal disease, and shingles vaccine doses administered to Medi-Cal participants increased by 44.4%, according to a statement on the policy brief.

“It’s a step toward making adult immunizations more accessible for more Californians," Ozlem Equils, MD, lead author of the study, says in the release. Now the authors hope the rest of the state will follow suit.