Managed Care - August 2008 - (Page 34) tients need to be vaccinated, especially in populations that are particularly vulnerFailure to be vaccinated for influenza able. That includes older members and is costly — even deadly people with chronic diseases. They adhe economic effect of the failure of adults to receive adevise those members to get immunized. quate vaccination is astounding. The most extensive fig“We use various forms of messaging, ures relate to influenza: According to the Centers for Disease including letters to members and conControl & Prevention, an average of 36,000 deaths and more tacting physicians,” says Belman. He does than 200,000 hospitalizations associated with influenza happoint to a problem using claim data in repen every year in the United States, the majority among lation to flu vaccines. Many people readults 65 and older. ceive their vaccines at public health clinThe overall national economic burden of illness attributable ics, “which can make it difficult to know to influenza in adults ages18–64 is $10.2 billion, according to who has failed to be inoculated.” the CDC. Every year, 17 million work days are lost to influenza Health plans base their criteria on what or related illness at a cost of $5.6 billion. vaccines to cover on guidelines publicized by the CDC’s Advisory Committee on Immunizasometimes leading to blindness. Adults are at risk tion Practices (ACIP), which consists of 15 experts if they had chicken pox as a child, or even if they in fields associated with immunization. previously had shingles. Notwithstanding ACIP recommendations, the The CDC recommends that people 60 and older cost to patients for vaccinations varies significantly be vaccinated against shingles by a single dose of the among plans. Some have first-dollar coverage for zoster vaccine Zostavax. This new recommendation some vaccines, especially for influenza vaccine, and replaces a provisional recommendation that the charge significant copayments for others. Plan ofCDC made in 2006, after the vaccine was licensed ficials say they are showing an increasing initiative by the U.S. Food and Drug Administration and in encouraging members to be vaccinated. recommended by the ACIP. That may be in response to infectious-disease exResearchers found that in those age 60 and above, perts and public health officials pushing hard for a the vaccine reduced the occurrence of shingles by national program to make immunization routine. about 50 percent. For people ages 60–69, it reduced The American Medical Association, for example, occurrence by 64 percent. That’s good news, behas implemented a program to encourage its memcause more than 95 percent of people are infected bers to recommend vaccinations to adults. by the varicella zoster virus during their lifetime. Cigna offers on-site flu shot clinics to its cusACIP recommends that women 19 or older retomers in an alliance with Summit Health, a proceive the human papillomavirus vaccine (HPV), vider of on-site health screening and immunization which has demonstrated significant effectiveness in programs. Clinics are held at work sites and are reducing cervical cancer. The vaccine has been conscheduled based on employer requests. Other plans troversial, however. Although its effectiveness has have similar programs. led some state legislatures to consider making it available to teenagers for free, some organizations have opposed the idea, stating they believe the vacShingles & HPV cine encourages promiscuity. Immunization rates Evidence is strong, however, that adults are failfor older women remain low. ing to take advantage of newer and less readily What is incontrovertible is the value of immuavailable vaccines. nization. WellPoint, for example, provides flu vacThe shingles vaccine, developed by Merck, was cines to all its employees. “Once these drugs are apapproved in 2006, and is now recommended for all proved by the FDA, virtually all health plans see the adults over 60, but only 1.9 percent of adults have value to making them available to their members been immunized for the disease, according to the within their benefit design, and most certainly take CDC. Shingles, a reawakening of the chicken pox steps to educate their members,” says Belman. “We virus, can result in severe nerve pain that can last strongly believe in their value.” MC for years, and can involve nerves around the eye, T 34 MANAGED CARE / AUGUST 2008
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