Managed Care - January 2008 - (Page 13) MEDICATION MANAGEMENT Should Pharmacists Be Allowed To Vaccinate Their Patients? Although federal health agencies support the idea of having pharmacists administer vaccines to their patients, the roadblock continues to be a question of payment By Martin Sipkoff ach year, nearly 90,000 Americans die of infections that can be prevented by vaccination, such as influenza, pneumococcal disease, and hepatitis B, according to the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control & Prevention. Influenza and pneumonia together are the fifth leading cause of American deaths. Pharmacists can play an important role in lowering that number by administering immunizations, say many health care officials. Unfortunately most health plans do little to encourage pharmacists to administer vaccinations, even though the idea is advocated by several professional and government organizations, including the American College of Physicians and the Centers for Disease Control & Prevention (CDC). Administration of at least some immunizations, especially influenza and pneumonia vaccines, is legal in at least 44 states, according to the American Society of HealthSystem Pharmacists. “Immunization has repeatedly been shown to be cost-effective. In fact, it may be the most cost-effective practice in medicine,” says John D. Grabenstein, PhD, a pharmaco-epidemiologist in the U.S. Army Medical Command who has written extensively about immunization by pharmacists, including the guidelines published by the American Society of Health-System Pharmacists. “But third-party reimbursement policies often do not provide coverage for recommended vaccines, despite the evidence.” That may change, according to several health plan officials. Beginning Jan. 1, Medicare will pay administration costs ($20 per immunization) for vaccines covered under the Part D E drug benefit. Until the beginning of this year, enrollees had to pay for their own shots. And subsequently CMS announced it supports pharmacists as vaccinators. “Where it is safe to dispense and administer vaccines in a pharmacy, health plans could explore utilization of their own pharmacists as providers of adult Medicare Part D vaccines,” said a recent policy statement to Part D prescription drug plans (PDPs) from Cynthia Tudor, director of CMS’s Medicare Drug Benefit Group. Until now Part D has allowed PDPs to charge a separate fee for administration. CMS now requires PDPs to include the cost of vaccine administration, along with ingredient cost and any dispensing fee, in their negotiated price for a vaccine. And the agency now forbids PDPs from charging enrollees separate copayments and coinsurance fees for vaccines and their administration. Medicare Part B Medicare’s payment policies for the administration of influenza and pneumococcal vaccines will continue under Part B, as will the cost of those vaccines. Hepatitis B vaccine and its administration will be covered under Part B when the vaccine is used to prevent disease in beneficiaries with an intermediate or high risk of hepatitis B infection. But many recommended vaccines are not covered by Part B. The ACIP recommends, for example, that all adults receive a tetanus booster shot every 10 years. The ACIP immunization schedule does include several products eligible under Part-D, including measles, mumps, rubella, chickenpox, and hepatitis A vaccine — all recommended for patients with diabetes and people over 65. CMS wants Part D plan sponsors to imple- Contributing Editor Martin Sipkoff is a long-time health care journalist. JANUARY 2008 / MANAGED CARE 13
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