Does your extended medical coverage include vaccines? If you’re unsure, you’re not alone.
When asked if vaccination coverage is included in their plans, 68% of plans sponsors said yes, according to third-party market research sponsored by GlaxoSmithKline Inc. (GSK). However, the TELUS Health Employer Database showed that in 2011, only 45% actually had coverage.
The GSK research found that 96% of plans sponsors that did provide coverage did not know what the cost of vaccines were or how it fit into their overall budget.
In times of cost controls and tightening drug spend, this lack of knowledge is concerning.
Scott Strong, national manager, private markets, public affairs and reimbursement, with GSK, presented these numbers at the 2012 Face to Face: Drug Plan Management conference in Toronto on December 5.
Cost not the issue
On average, Canadian plan sponsors spent $7.44 per plan member on vaccines in 2011, according to IMS/Brogan private vaccine sales data.
Seventy-seven percent of plan sponsors said that the cost for coverage was reasonable, and 87% agreed that offering vaccination coverage was worth it.
“We cover all vaccines,” said Wendy Jackson, manager, Canadian benefit programs, with Magna International Inc. “It really has a small impact on our plan. It’s less than 1% of our drug spend.”
She added that Magna has a very culturally diverse workforce with a high potential for travel, so for Magna, it’s “helpful to have in place.”
But vaccines are for more just than travel. The Public Health Agency of Canada recommends a host of vaccines for adults—ones that many people don’t get, such as tetanus, diphtheria and varicella.
“A surprising number of plan sponsors would have included it had it been offered as part of their plan design,” said Strong, summarizing the data. In fact, when asked, 53% of plan sponsors said they wish they did know more about vaccines.
“It needs to become part of the plan design conversation,” he said. The GSK data show that 69% of consultants generally recommend including vaccine coverage, while only 34% of insurers do the same.
Strong said that health and benefits plans are becoming proactive and that more focus is placed on wellness.
According to the GSK research, 75% of plan sponsors indicated that their ideal plan would have both therapeutic treatments and proactive measures that promoted overall wellness, whereas only 47% of plan sponsors said that their plans currently had that approach.
For plan sponsors, the main reason for including vaccine coverage is part of an overall wellness strategy.
However, Strong said that removing coverage barriers likely wouldn’t increase adult vaccine rates because the biggest problem is lack of knowledge about vaccines.
“We need to ramp up the knowledge level about participating in adult vaccine schedules,” he said. Doing so will promote wellness, and well employees are beneficial for everyone.