"There is plenty of vaccine available in the United States, but you can't give it to everyone until October 24."
"Our plan does cover the influenza vaccine for our enrollees. We just don't reimburse you as much as it costs to purchase the vaccine."
Those two quotes sum up the biggest challenges of the 2005-2006 influenza vaccination program: namely, supply (including prioritization, although that constraint has passed) and reimbursement. Both issues have challenged physicians-particularly you, as a pediatrician-throughout the season. This briefing will answer important questions you may have about the current flu season.
Earlier, the CDC published guidelines for administering the injectable trivalent inactivated vaccine, or TIV, that were valid until October 24. Some of the patients listed as at high risk in those guidelines, such as health-care workers, may also qualify for the intranasal live attenuated influenza vaccine (LAIV), for which no date restrictions were set (refer to CDC guidelines at http://www.cdc.gov/ to determine which subgroups of your patient population are candidates for LAIV). The following groups, considered at high risk, should have been vaccinated with TIV before October 24 (and, of course, should still be vaccinated if they were not):
Again, regarding the need earlier this season to prioritize vaccination, I emphasize that all people (with the exception, of course, of those who have a medical contraindication) have been eligible for the influenza vaccine since October 24.
To meet demand, your practice will stock a combination of the Vaccines for Children (VFC) supply and privately purchased vaccine from one of four manufacturers licensed in the United States: Sanofi Pasteur, Chiron, and GlaxoSmithKline, which produce TIV; and MedImmune Vaccines, which produces LAIV. Even with several manufacturers involved, there was uncertainty early on regarding the adequacy of the supply of vaccine in the United States-which is why the CDC focused first on delivering immunity to members of high-risk groups.
For most of your colleagues, 2005-2006 is the third season in which the influenza vaccine plays a major role in their practice. Because of this experience, most practices already have a system in place for vaccinating a large number of children. Typically, large practices use a weekend vaccine clinic model to create an opportunity to vaccinate many children in a short time.
Many pediatric practices have also found a way to determine how many doses of vaccine will be needed to satisfy demand. If your practice has not done this, the box at left offers a formula and a sample calculation (using an assumption that all doses of the vaccine will be TIV). A practice can reasonably predict how many doses to order for the recommended groups, but deciding the total order is difficult: On one hand, you need to have enough doses to meet demand; on the other, ordering too much vaccine can place a significant financial burden on the practice.
How does vaccine reimbursement affect your practice?
Pay particular attention to reimbursement for both TIV and LAIV. Every payer reimburses at a different level, and many are providing reimbursement at less than the cost of the vaccine to the practice! Some payers reimburse for the vaccine and for administering it, which may bring reimbursement to an adequate level. Also, be aware that, first, the price of influenza vaccine rose this year and, second, the cost of, and reimbursement for, TIV and LAIV are different. Your practice must be judicious in monitoring flu vaccine-related expenses and reimbursement or it is likely to lose money on a flu vaccination program.