photo Courtesy of Heather Hazzan , SELF Magazine
Elaborating on what ' s still missing , Vinson added , “ These administration fee policy changes with Arkansas Medicaid are welcome , but more policy changes are needed if we seek to further strengthen our states ’ immunization infrastructure in response to the global pandemic ” “ So far , the state has not addressed reimbursement on the ingredient side . We asked for the CPT billing codes for adult vaccines to be reviewed and adjusted consistent with adequate compensation – by reviewing other state Medicaid programs , Medicare , private insurance , and established pricing standards like Average Wholesale Price and Wholesale Acquisition Cost .
“ The most egregious example of the broken policy is pneumococcal vaccine , 23 valent , with CPT code 90732 . 90732 reimburses $ 12.34 and likely has not been reviewed or updated since the 1980s when the vaccine first came to market . Today , the vaccine average cost for providers to purchase is around $ 100 per dose . For comparison , state Medicaid programs like Florida and Mississippi reimburse between $ 105 and $ 130 . In Arkansas Medicaid , the total reimbursement is $ 25.48 , compared to more than $ 135 total in Medicare B in Arkansas . This out-of-date policy leads to lack of access for these vaccines for this vulnerable patient population . Updating the policy would result in less death and permanent disability ( from neurological and other organ damage from this horrific illness ) as well as lower costs to tax payers from vaccine-preventable disease complications .
“ Finally , Arkansas Medicaid has not yet addressed the request to provide adult coverage for all CDC ACIP recommended vaccines , contrasting with their appropriate policy in pediatrics where the Vaccines For Children program does purchase and cover all CDC ACIP recommended vaccines . If they were to grant our requests in these remaining areas , it would help state immunization rates rise and result in Medicaid cost savings by preventing spending on treatment related to medical complications of vaccine-preventable illnesses .”
Flu Season is Here , COVID-19 Notwithstanding
It ’ s safe to say it ’ s going to be a different flu season this year . “ It complicates the clinical picture ,” said ADH Medical Director for Immunizations and Outbreak Response Jennifer Dillaha , MD . “ With a lot of flu circulating , you have more people with respiratory symptoms , so you have to distinguish between flu and COVID . Also , we have many hospitalizations related to the flu . Last year ( fall 2019-spring 2020 ), we had 105 flu deaths and close to 1,300 hospital admissions . Can you imagine having those hospitalizations along with those we ’ ve had with COVID-19 ? It could very much stress our system .
“ We ’ ve had 4,182 hospitalizations related to COVID since early March . That ’ s why flu vaccines are so important . The more people we can keep out of the hospital with flu , the better . This comes down to individual patient care . We know that the people who do most poorly with COVID-19 are the people who do most poorly with influenza . It ’ s the elderly and the people with chronic health conditions . Fortunately , children tend to do better with COVID-19 than
Jennifer Dillaha , MD , ADH Medical Director for Immunizations and Outbreak Response
they do with flu . We have children that die every year from the flu . You can imagine what it might do to someone who got both . Fortunately , with flu , we have treatment and a vaccine .”
Alongside the impediment of distinguishing flu from COVID-19 is the realization that flu immunization clinics will be fewer and smaller this year . ADH has offered drive-through clinics since late September , but they ’ re nothing like those of past years . “ Before , we had mass clinics where everyone could line up and get their flu shot ,” she added . “ This year , you can ’ t line up , so many local health units are incorporating flu with drive-up COVID testing . So , you could get a COVID test and a flu shot , or you could get just a flu shot or just a COVID test .”
With this in mind , Dr . Dillaha encourages clinics and pharmacies – if they haven ’ t done so already – to develop their own drive-up or drive-by system for offering vaccinations .
Another thing to note this year is that nasal flu vaccines are not recommended . Dr . Wheeler explained , “ Nasal vaccines have always been an option for adults and children . We ’ re discouraging that because of the risk of somebody sneezing and such with COVID-19 . Most people are ordering the injectable vaccine instead .
“ We know that the things you do to keep from getting COVID-19 keep you from getting the flu or the common cold . So , we ’ re hopeful that we ’ ll see a drop in some of those pathogens in terms of frequency IF – capital I , capital F – people
photo Courtesy of Heather Hazzan , SELF Magazine
104 • The Journal of the Arkansas Medical Society www . ArkMed . org