A recent IQVIA report explores the relationship between Medicaid reimbursement rates at the state level for influenza vaccine delivery by healthcare providers to Medicaid fee-for-service (FFS) recipients and the resulting vaccination rates among these populations, with a focus on the 2022-23 flu season. It underscores the essential role of adult vaccination in promoting healthy aging and enhancing public health, highlighting the challenge of significantly lower vaccination rates among adults in the U.S., especially among vulnerable groups like Medicaid recipients.
The study reveals notable disparities in Medicaid reimbursement rates across states, with a particular emphasis on the impact of these variations on vaccination rates. It finds a significant positive association between higher pharmacy Medicaid reimbursement rates and increased vaccination rates among Medicaid FFS recipients, but no such correlation for reimbursements to physician offices.
The report emphasizes the critical role pharmacists play in vaccine administration and suggests that equitable reimbursement policies are vital for improving adult Medicaid vaccination rates. It calls for policies aimed at reducing barriers to vaccination for both patients and providers, including the elimination of out-of-pocket costs and enabling pharmacists to administer vaccines. The study also notes the potential benefits of aligning Medicaid reimbursement rates more closely with those of Medicare to improve vaccination uptake among Medicaid recipients.
To conduct the analysis, the study utilized vaccine uptake data and state-level reimbursement rates for vaccine provision by pharmacies and office-based physicians. A multiple regression model was employed to examine how reimbursement influences vaccination rates, accounting for state-specific variables such as per capita income and the percentage of college-educated adults. The methodology involved estimating the total reimbursement amounts and analyzing Medicaid coverage and reimbursement policies for adult influenza vaccines across all states.
The findings aim to guide policy measures to enhance vaccine access and utilization among low-income or Medicaid groups, highlighting the need for comprehensive strategies that include increased education, outreach, and access, alongside adjustments in reimbursement policies.
Variability in State Medicaid Reimbursements for Adult Flu Vaccine Administration and Supply
The approach to reimbursing office-based providers for adult flu vaccine supply varies; some states reimburse at the vaccine’s acquisition cost, while others set a specific fee. The most commonly used Medicaid reimbursement rates for adult flu vaccine CPT codes (90672 and 90674) were collected, and the CDC’s Adult Influenza Vaccine Price List figures for 2022–2023 were subtracted to determine the private sector cost per dose. This subtraction helped estimate the vaccine supply component of the total reimbursement, noting instances where providers may receive less than the vaccine’s acquisition cost.
In states permitting billing for an office visit during flu vaccination, the Medicaid fee-for-service reimbursement rates for basic adult visits using evaluation/management (E/M) codes (99202, 99203, 99212, 99213) were collected. When applicable, this office visit fee was added to the vaccine administration and supply costs to calculate the total reimbursement. Reimbursement methods for pharmacies administering adult flu vaccines vary, including professional dispensing fees, standard vaccine administration CPT codes, or unique vaccine administration fees. These fees were compiled to estimate the total reimbursement amount for pharmacies by state Medicaid programs for administering flu vaccines to adults aged 19 to 64.
States differ in their reimbursement approaches for pharmacies regarding the flu vaccine supply. Data on Medicaid’s fee-for-service rates for adult flu vaccines were collected, noting whether states reimburse the vaccine’s acquisition cost or use a different fee-setting methodology. This helped estimate the vaccine supply part of the total reimbursement, highlighting cases where pharmacies may be reimbursed below the vaccine’s acquisition cost.
Analyzing the Impact of Medicaid Reimbursement Rates on State-Level Flu Vaccination Rates
Longitudinal Prescription Claims (LRx) and Medical and Institutional Claims (Dx and Hx) databases were used to estimate state-level flu vaccination rates from June 2022 to May 2023, with patients being categorized by their pay type. This analysis provided state-level vaccination rates, with further demographic breakdowns possible through additional data sources like the Experian ConsumerView marketing database for race/ethnicity and income information. However, it’s important to note that not all vaccinations captured in these databases are associated with an insurance claim.
An ordinary least squares linear multiple regression was applied to explore the relationship between Medicaid FFS reimbursement rates (for both office-based providers and pharmacies) and state-level flu vaccination rates. This model included state-level variables like per capita income and the percentage of college-educated adults to control for additional factors. Our analysis highlights a positive association between increased pharmacy Medicaid reimbursement rates and higher vaccination rates among the Medicaid FFS population, with a $13 increase in pharmacy reimbursement correlating with a roughly 6 percentage point increase in vaccination rates. However, the total reimbursement amount for office-based providers did not show a significant impact on adult flu vaccine uptake.
The total reimbursement amount for Medicaid Fee-for-Service (FFS) provided to pharmacies and physicians for influenza vaccination shows significant variation across states. Pharmacies experience reimbursement ranging from below the vaccine’s cost to about $25, with an average state reimbursement of approximately $12. Physician offices see a wider range, from below cost up to about $83, averaging around $22.50. Some states offer no additional reimbursement beyond vaccine cost, and in others, reimbursement falls short of covering the vaccine’s purchase price.
Boosting Flu Vaccination Rates Among Medicaid Recipients: The Role of Pharmacy Reimbursements
The study finds a significant positive link between pharmacy Medicaid reimbursement rates and influenza vaccination rates among Medicaid FFS adults. A $1 increase in pharmacy reimbursement correlates with a 0.43 percentage point rise in vaccination rates, after adjusting for factors like income and education levels. This association was not observed with physician office reimbursements.
Differences were explored across racial and ethnic groups, urban versus rural settings, and genders. The findings suggest a similar positive relationship between increased pharmacy reimbursement and higher vaccination rates in urban areas and among Black, white, and Hispanic populations, but not in rural settings or among the Asian population. The impact was consistent for both male and female Medicaid FFS recipients.
A notable finding is that a $13 hike in pharmacy reimbursement for influenza vaccine provision could lead to a 5.6 percentage point increase in vaccination rates among adult Medicaid FFS recipients. This correlation points to the potential of pharmacy reimbursement adjustments to influence vaccination rates positively. However, it’s emphasized that reimbursement increases should be part of broader strategies to improve vaccination rates, including education and improved access.
The study highlights the critical role of pharmacists in vaccine administration, showing that pharmacies are a key vaccination site for diverse populations, including racial and ethnic minorities and low-income individuals. This underscores the importance of equitable reimbursement practices to support vaccination efforts.
Low adult flu vaccination rates among Medicaid populations pose a challenge to public health and health equity. The study indicates that ensuring fair compensation for pharmacists is crucial for enhancing vaccine uptake and addressing disparities. While increasing pharmacy reimbursements may raise costs initially, the anticipated benefits in terms of higher vaccination rates and reduced healthcare complications are expected to outweigh these expenses in the long run. Nonetheless, addressing vaccination barriers comprehensively remains essential for improving vaccination outcomes among Medicaid recipients.
Resource: IQVIA, February 27, 2024
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