Requiring Insurers to Cover Retail Pharmacy Vaccinations for Adult Californians Could Save Lives, Study Finds
Requiring health insurers to pay for adult vaccinations given at retail pharmacies could help prevent the spread of deadly communicable diseases such as influenza, pneumococcal infection and human papillomavirus, according to a new study by the
Many insurers do not cover pharmacy-administered vaccines; cover a limited selection of vaccines; or require people they insure to get vaccinated only at pharmacies within their insurance network, the study reports.
Overall vaccination rates in state are low
The overall vaccination rate among adult Californians is far below federal recommendations, according to the study. For example, the flu vaccination rate in
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Influenza and pneumonia-related illnesses contributed to an estimated 57,000 deaths in the country in 2015-16, making it one of the top 10 leading causes of death, according to data from the
Racial disparities in vaccination rates
While
Barriers to getting immunized
Many barriers keep adult Californians from getting immunized, according to the study. These include:
* Confusing and inconsistent insurance policy coverage. A patient may have difficulty knowing if their commercial or government insurance program covers pharmacy vaccine benefits. As a result, some customers forgo vaccination because of potential or actual out-of-pocket cost.
* Unaffordable upfront costs. Some patients are required to pay upfront for vaccinations at a pharmacy and file a claim in order to get reimbursement, a hardship for low-income adults.
* Lack of access to a doctor. Scheduling an appointment for immunization can be difficult for patients who lack a regular care provider.
* Unawareness or personal objections. Lack of knowledge about the benefits of adult vaccines; the health system's focus on child vaccinations and its lack of prioritization about adult vaccinations; and cultural suspicion about vaccinations all can hinder immunization.
The study's authors recommend that the state Legislature require the
"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
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