“Immunization is one of the best investments money can buy, according to the World Health Organization,” said Johnny Ma, president at Mapol Inc., during a session supported by GSK, Merck and Pfizer Canada during Benefits Canada’s 2025 Face to Face Drug Plan Management Forum.
Canadian data shows vaccines can save $2.5 billion a year in unnecessary health costs and lost productivity, with a 341 per cent return on every dollar spent, he said. But despite these benefits, significant gaps remain. “Private plans nationally paid about $326 million in vaccine claims; however, 1.5 million claims were rejected.”
Ma also highlighted that only 71 per cent of Canadians with private insurance have vaccine coverage, leaving about seven million without. The gap is even larger for small businesses, where 46 per cent don’t include vaccines in their plans. Insurer’s classifications of vaccines as lifestyle or optional is a legacy from when vaccines were primarily for children and were publicly funded, he noted “The landscape has changed but their policies have not modernized.”
Read: 2024 Face to Face Drug Plan Management Forum: Panel: A look at the evolution of drug coverage
Ma also pointed out administrative barriers, such as requiring a doctor’s prescription for Schedule 2 vaccines, which are available behind the counter at pharmacies and don’t legally require a prescription. “Why should plan members be asked to get a prescription when six million individuals don’t have a family doctor in Canada today?”
Sharing highlights of Mapol’s 2025 vaccine coverage report card, which graded insurers on how they include vaccines in their benefits plans, he said seven insurers achieved an A grade for group benefits, with Sun Life recognized for consistency across group and personal health plans. Others, such as the Co-operators Group Ltd., the Empire Life Insurance Co., Desjardins Insurance, Group Medical Services, RBC Insurance Services Inc. and Saskatchewan Blue Cross, were also identified for leadership.
However, he noted eight insurers still treat vaccines as optional and six received an E grade, meaning coverage is only provided if plan sponsors request it.
Read: 2024 Vancouver Benefits Summit: How plan sponsors can boost vaccine uptake among employees
Ma recommended that “insurers make vaccines a standard inclusion now — not next year, not the next product review, not when it’s convenient, now. The economics and public health evidence support it and plan sponsors’ employees need it.”
He urged plan sponsors to proactively request vaccine coverage and communicate it to employees and for advisors to advocate for standard vaccine inclusion and to educate plan sponsor clients on its importance.
Read more coverage of the 2025 Face to Face Drug Management Forum.